Provider Demographics
NPI:1740700566
Name:NORTHWOODS PT LLC
Entity type:Organization
Organization Name:NORTHWOODS PT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MISTEN
Authorized Official - Middle Name:
Authorized Official - Last Name:BOYSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:720-255-6992
Mailing Address - Street 1:5782 US HIGHWAY 31 N
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:MI
Mailing Address - Zip Code:49690-9312
Mailing Address - Country:US
Mailing Address - Phone:231-938-2425
Mailing Address - Fax:
Practice Address - Street 1:5782 US HIGHWAY 31 N
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:MI
Practice Address - Zip Code:49690-9312
Practice Address - Country:US
Practice Address - Phone:231-938-2425
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-22
Last Update Date:2017-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501016687225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty