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2125 Wrenwood St Sw Ofc Therapist Wyoming MI 49519-2362 | |
| (616) 530-7590 | |
| (616) 249-7673 |
| Full Name | |
|---|---|
| Speciality | Clinic/Center |
| Location | 2125 Wrenwood St Sw Ofc Therapist, Wyoming, Michigan |
| Authorized Official Name and Position | Tasha Blackmon (CEO) |
| Authorized Official Contact | 6169658215 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
100 Cherry St Se Grand Rapids MI 49503-4526 Ph: (616) 965-8200 | 2125 Wrenwood St Sw Ofc Therapist Wyoming MI 49519-2362 Ph: (616) 530-7590 |
| NPI Number | 1265081418 |
|---|---|
| Provider Enumeration Date | 09/10/2019 |
| Last Update Date | 08/25/2023 |
| Certification Date | 08/25/2023 |
| Medicare PECOS PAC ID | 6800707647 |
|---|---|
| Medicare Enrollment ID | O20200403000481 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1265081418 | NPI | - | NPPES |
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