Provider Demographics
NPI:1295995629
Name:PHYSICAL THERAPY SERVICES OF GRAND RAPIDS, LLC
Entity type:Organization
Organization Name:PHYSICAL THERAPY SERVICES OF GRAND RAPIDS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MS
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:LOU
Authorized Official - Last Name:CARRIER
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:616-481-3690
Mailing Address - Street 1:4070 LAKE DR SE
Mailing Address - Street 2:SUITE: 204
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-8294
Mailing Address - Country:US
Mailing Address - Phone:616-481-3690
Mailing Address - Fax:
Practice Address - Street 1:4070 LAKE DR SE
Practice Address - Street 2:SUITE: 204
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-8294
Practice Address - Country:US
Practice Address - Phone:616-481-3690
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-10
Last Update Date:2008-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy