Provider Demographics
NPI:1356731954
Name:LANEUVILLE, MARIE A (PT)
Entity type:Individual
Prefix:
First Name:MARIE
Middle Name:A
Last Name:LANEUVILLE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:25 MICHIGAN ST NE
Mailing Address - Street 2:SUITE 3300
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-2515
Mailing Address - Country:US
Mailing Address - Phone:616-459-4171
Mailing Address - Fax:616-459-0044
Practice Address - Street 1:25 MICHIGAN ST NE
Practice Address - Street 2:SUITE 3300
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-2515
Practice Address - Country:US
Practice Address - Phone:616-459-4171
Practice Address - Fax:616-459-0044
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-03
Last Update Date:2015-02-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5501012042225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist