Organization
BLUE SKY PHYSICAL THERAPY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WENDELL WHITE (OWNER)
(785) 435-6356
Entity
Organization
Contact information
Practice address
21600 HARPER AVE, ST CLR SHORES, MI 48080-2242
(678) 543-5635
Mailing address
21600 HARPER AVE, ST CLR SHORES, MI 48080-2242
(678) 543-5635
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PENDING
—
MI
Enumeration date
06/27/2019
Last updated
06/27/2019
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