Organization
DIVERSIFIED PHYSICAL THERAPY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. KEVIN E SPRAGUE PT (CO-OWNER)
(231) 755-4404
Entity
Organization
Contact information
Practice address
1595 W SHERMAN BLVD, MUSKEGON, MI 49441-3542
(231) 755-4404
(231) 755-7704
Mailing address
4358 CAROLYN ST, MUSKEGON, MI 49444-4468
(231) 755-4404
(231) 755-7704
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
5501006200
MI
Other
Enumeration date
08/27/2007
Last updated
09/26/2007
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