Provider Demographics
NPI:1255535050
Name:LONGMORE, JOHN JOSEPH JR (PTA)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:JOSEPH
Last Name:LONGMORE
Suffix:JR
Gender:M
Credentials:PTA
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Mailing Address - Street 1:415 E CHIPPEWA ST
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:MI
Mailing Address - Zip Code:48858-1613
Mailing Address - Country:US
Mailing Address - Phone:989-773-9404
Mailing Address - Fax:
Practice Address - Street 1:1234 E BROOMFIELD ST
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:MI
Practice Address - Zip Code:48858-4491
Practice Address - Country:US
Practice Address - Phone:989-773-1333
Practice Address - Fax:989-773-1303
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-14
Last Update Date:2007-07-08
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant