Provider Demographics
NPI:1457890592
Name:ESSENCE PHYSICAL THERAPY, INC.
Entity Type:Organization
Organization Name:ESSENCE PHYSICAL THERAPY, INC.
Other - Org Name:ESSENCE PHYSICAL THERAPY
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:RACHEL
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:DAVIES
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:616-481-6661
Mailing Address - Street 1:537 GLADSTONE DR SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49506-2816
Mailing Address - Country:US
Mailing Address - Phone:616-481-6661
Mailing Address - Fax:
Practice Address - Street 1:1324 LAKE DR SE
Practice Address - Street 2:SUITE 3
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49506-1673
Practice Address - Country:US
Practice Address - Phone:616-481-6661
Practice Address - Fax:844-965-9569
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-22
Last Update Date:2017-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501011332225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty