Organization
DIVERSIFIED PT
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DEBORAH SPRAGUE (PTA)
(231) 755-4404
Entity
Organization
Contact information
Practice address
1635 W SHERMAN BLVD, NORTON SHORES, MI 49441-3544
(231) 755-4404
Mailing address
1635 W SHERMAN BLVD, NORTON SHORES, MI 49441-3544
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
5501009094
MI
Other
Enumeration date
09/16/2014
Last updated
09/16/2014
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