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
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