Organization
ORTHOPEDIC AND SPORTS PHYSICAL THERAPY CENTER, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RICARTHUR DANO LONTOC P.T. (PRESIDENT/PHYSICAL THERAPIST)
(269) 925-9491
Entity
Organization
Contact information
Practice address
1850 PIPESTONE RD, SUITE 202, BENTON HARBOR, MI 49022-2304
(269) 925-9491
(269) 925-9553
Mailing address
PO BOX 8704, BENTON HARBOR, MI 49023-8704
(269) 925-9491
(269) 925-9553
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
5501004651
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
305174
CHP #, HEALTH PLAN MNGT
MI
05
—
479640
—
MI
01
—
64-30126
IBA/PHP PROVIDER NUBMER
MI
Enumeration date
08/10/2006
Last updated
08/22/2020
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