Provider Demographics
NPI:1669205282
Name:PT CENTRAL PLLC
Entity type:Organization
Organization Name:PT CENTRAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:DEHAAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:616-446-6158
Mailing Address - Street 1:3200 SAINT ANDREWS DR
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:MI
Mailing Address - Zip Code:48858-9070
Mailing Address - Country:US
Mailing Address - Phone:616-446-6158
Mailing Address - Fax:
Practice Address - Street 1:3200 SAINT ANDREWS DR
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:MI
Practice Address - Zip Code:48858-9070
Practice Address - Country:US
Practice Address - Phone:616-446-6158
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-20
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty