Organization
ORTHOPEDIC AND SPORTS PHYSICAL THERAPY CENTER, INC
Active
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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