Organization
BLUE WATER PHYSICAL THERAPY, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
VARDHAN MUDIGONDA P.T. (OWNER)
(810) 824-2038
Entity
Organization
Contact information
Practice address
1209 10TH ST STE A, PORT HURON, MI 48060-5262
(810) 824-2038
Mailing address
3560 PINE GROVE AVE # 614, PORT HURON, MI 48060-1994
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
Other
Enumeration date
06/30/2006
Last updated
08/22/2020
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