Organization
CROSWELL MANUAL THERAPY, INC
Active
Parent organization
CROSWELL MANUAL THERAPY INC
Other names
Athletic & Manual Therapy Services
Organization subpart
Yes
Provider details
NPI number
Legal business name
CROSWELL MANUAL THERAPY INC
Authorized official
MR. JONATHAN SISON DEL ROSARIO PHYSICAL THERAPIST (DIRECTOR)
(810) 404-8411
Entity
Organization
Contact information
Practice address
4990 N VAN DYKE, KINDE, MI 48445-0004
(989) 874-4600
Mailing address
PO BOX 4, KINDE, MI 48445-0004
(989) 874-4600
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
5501007571
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0N97200
MEDICARE PROVIDER NUMBER
MI
01
—
650G610300
BCBS
MI
Enumeration date
12/18/2007
Last updated
06/27/2008
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