Provider Demographics
NPI:1265898951
Name:WORKMAN, JOSEPH JOHN-KARL (MT)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:JOHN-KARL
Last Name:WORKMAN
Suffix:
Gender:M
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2424 BURTON ST SE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-4802
Mailing Address - Country:US
Mailing Address - Phone:616-551-2724
Mailing Address - Fax:
Practice Address - Street 1:2424 BURTON ST SE
Practice Address - Street 2:SUITE 101
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-4802
Practice Address - Country:US
Practice Address - Phone:616-551-2724
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-11
Last Update Date:2016-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7501007842225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist