Provider Demographics
NPI:1740466911
Name:ASSELIN, DAVID A (PT, DPT)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:A
Last Name:ASSELIN
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1502 WEALTHY ST SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49506-2719
Mailing Address - Country:US
Mailing Address - Phone:616-456-0360
Mailing Address - Fax:616-456-0361
Practice Address - Street 1:1502 WEALTHY STREET SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49506
Practice Address - Country:US
Practice Address - Phone:616-456-0360
Practice Address - Fax:616-456-0361
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-17
Last Update Date:2013-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501013640225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5501013640OtherPHYSICAL THERAPY LICENSE