Provider Demographics
NPI:1255372066
Name:NEPHEW SERVICES, LLC
Entity type:Organization
Organization Name:NEPHEW SERVICES, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER, PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:NEPHEW
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT
Authorized Official - Phone:616-283-1489
Mailing Address - Street 1:2905 WILLOW TERRACE CT
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49424-7919
Mailing Address - Country:US
Mailing Address - Phone:616-283-1489
Mailing Address - Fax:616-738-1489
Practice Address - Street 1:91 DOUGLAS AVE
Practice Address - Street 2:SUITE 140
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49424-2188
Practice Address - Country:US
Practice Address - Phone:616-283-1489
Practice Address - Fax:616-738-1489
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501010233225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty