Organization
ORTHOPEDIC PHYSICAL THERAPY SPECIALIST LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. PAUL FREDERICK PT (OWNER)
(269) 637-9099
Entity
Organization
Contact information
Practice address
02957 73RD ST, SOUTH HAVEN, MI 49090-9364
(269) 637-9099
(269) 637-9224
Mailing address
02957 73RD ST, SOUTH HAVEN, MI 49090-9364
(269) 637-9099
(269) 637-9224
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
5501011004
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4800853-10
—
MI
Enumeration date
06/04/2007
Last updated
03/01/2013
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