Provider Demographics
NPI:1891300034
Name:BOERSMA, EMILY
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:BOERSMA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:R
Other - Last Name:BODE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:8872 PROFESSIONAL DR
Mailing Address - Street 2:
Mailing Address - City:CADILLAC
Mailing Address - State:MI
Mailing Address - Zip Code:49601-8481
Mailing Address - Country:US
Mailing Address - Phone:231-876-0010
Mailing Address - Fax:231-876-0241
Practice Address - Street 1:8872 PROFESSIONAL DR
Practice Address - Street 2:
Practice Address - City:CADILLAC
Practice Address - State:MI
Practice Address - Zip Code:49601-8481
Practice Address - Country:US
Practice Address - Phone:231-876-0010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-14
Last Update Date:2025-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501019569225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist