Organization
LAKE ISABELLA PHYSICAL THERAPY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SHANNON MARIE DEXTER PT, DPT (PRESIDENT, PT, DPT)
(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
225100000X
Physical Therapist
5501014675
MI
225200000X
Physical Therapy Assistant
Primary
5502001683
MI
225200000X
Physical Therapy Assistant
5502003378
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1376811729
PTAN MI5338
MI
05
—
UNVLIPT2011
—
MI
Enumeration date
08/08/2014
Last updated
08/08/2014
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