Provider Demographics
NPI:1558632661
Name:FREEDOM PHYSICAL THERAPY LLC
Entity type:Organization
Organization Name:FREEDOM PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:HOWARD
Authorized Official - Last Name:FREEHAFER
Authorized Official - Suffix:JR
Authorized Official - Credentials:PT
Authorized Official - Phone:616-277-1599
Mailing Address - Street 1:7885 BYRON CENTER AVE SW
Mailing Address - Street 2:SUITE A
Mailing Address - City:BYRON CENTER
Mailing Address - State:MI
Mailing Address - Zip Code:49315-8199
Mailing Address - Country:US
Mailing Address - Phone:616-277-1599
Mailing Address - Fax:616-277-1626
Practice Address - Street 1:7885 BYRON CENTER AVE SW
Practice Address - Street 2:SUITE A
Practice Address - City:BYRON CENTER
Practice Address - State:MI
Practice Address - Zip Code:49315-8199
Practice Address - Country:US
Practice Address - Phone:616-277-1599
Practice Address - Fax:616-277-1626
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-20
Last Update Date:2012-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501003194225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty