Organization
MITTEN STATE PEDIATRIC THERAPY LLC
Active
Organization
MITTEN STATE PEDIATRIC THERAPY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LINDSAY DAMMAR (CO-OWNER)
(248) 535-4666
Entity
Organization
Contact information
Practice address
5258 PLAINFIELD AVE NE STE A, GRAND RAPIDS, MI 49525-1092
(616) 466-4068
(616) 369-1646
Mailing address
6659 CRAFTSMAN SQUARE DR NE, ROCKFORD, MI 49341-8861
(248) 535-4666
Taxonomy
Speciality
Code
Description
License number
State
2081P0010X
Pediatric Rehabilitation Medicine Physician
—
—
225100000X
Physical Therapist
—
—
225X00000X
Occupational Therapist
Primary
—
—
235Z00000X
Speech-Language Pathologist
—
—
Other
Enumeration date
07/29/2020
Last updated
09/11/2023
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