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Organization
VITALITY AT HOME
Active
Organization
VITALITY AT HOME
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JENNAFER SMITH DPT, GCS (PHYSICAL THERAPIST)
(612) 839-9040
Entity
Organization
Contact information
Practice address
247 LUCE ST SW, GRAND RAPIDS, MI 49534-9607
(612) 839-9040
Mailing address
247 LUCE ST SW, GRAND RAPIDS, MI 49534-9607
(612) 839-9040
Taxonomy
Speciality
Code
Description
License number
State
2251G0304X
Geriatric Physical Therapist
Primary
—
NULL
2251G0304X
Geriatric Physical Therapist
Primary
—
—
Other
Enumeration date
12/18/2019
Last updated
12/27/2019
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