Organization
FITNESS CENTER PHYSICAL THERAPY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JEFFREY W HOLMAN (PRESIDENT)
(231) 941-1800
Entity
Organization
Contact information
Practice address
425 BOARDMAN AVE, TRAVERSE CITY, MI 49684-2562
(231) 941-1800
(231) 941-7021
Mailing address
425 BOARDMAN AVE, TRAVERSE CITY, MI 49684-2562
(231) 941-1800
(231) 941-7021
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
30369
BLUE CROSS PROVIDER NUMBE
MI
Enumeration date
01/30/2007
Last updated
08/22/2020
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