Organization
LAKE ISABELLA PHYSICAL THERAPY, LLC
Active
Organization
LAKE ISABELLA PHYSICAL THERAPY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SHANON MARIE DEXTER PT, DPT (OWNER, PHYSICAL THERAPIST)
(989) 546-7490
Entity
Organization
Contact information
Practice address
50 N COLDWATER RD, SUITE D, WEIDMAN, MI 48893-8845
(989) 546-7490
(989) 546-7298
Mailing address
50 N COLDWATER RD, SUITE D, WEIDMAN, MI 48893-8845
(989) 546-7490
(989) 546-7298
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
5501014675
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1598084667
NPI TYPE I
MI
01
—
5501014675
STATE LICENSE
MI
Enumeration date
12/13/2011
Last updated
12/15/2011
Update your record
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