Organization
SPORT TRACK PHYSICAL THERAPY AND HUMAN PERFORMANCE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JUSTIN PRICE DPT (OWNER)
(269) 362-5242
Entity
Organization
Contact information
Practice address
115 E MAIN ST, NILES, MI 49120-2224
(269) 362-5242
(269) 912-5922
Mailing address
3248 CHABOT RD, BENTON HARBOR, MI 49022-9526
(269) 362-5242
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1679055917
TYPE 1 NPI
MI
Enumeration date
08/03/2022
Last updated
08/26/2022
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