Provider Demographics
NPI:1295769123
Name:POST, PETER ANTHONY (PT)
Entity type:Individual
Prefix:MR
First Name:PETER
Middle Name:ANTHONY
Last Name:POST
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1446 N WALDRON RD
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL
Mailing Address - State:MI
Mailing Address - Zip Code:48818-9789
Mailing Address - Country:US
Mailing Address - Phone:269-910-8553
Mailing Address - Fax:
Practice Address - Street 1:11561 EDGERTON AVE NE
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:MI
Practice Address - Zip Code:49341-9150
Practice Address - Country:US
Practice Address - Phone:269-792-4410
Practice Address - Fax:269-792-4538
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI55010100932251X0800X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP40960003Medicare PIN