Organization
UPPER PENINSULS SPORTS MEDICINE & THERAPY CENTER
Active
Organization
UPPER PENINSULS SPORTS MEDICINE & THERAPY CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. DEBRA LEE NEVENHOVEN (OFFICE MANAGER)
(906) 228-2595
Entity
Organization
Contact information
Practice address
1414 W FAIR AVE, SUITE 101, MARQUETTE, MI 49855-2675
(906) 228-2595
(906) 228-3313
Mailing address
1414 W FAIR AVE, SUITE 101, MARQUETTE, MI 49855-2675
(906) 228-2595
(906) 228-3313
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
5501001972
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
30455
BLUE CROSS BLUE SHIELD
MI
Enumeration date
03/28/2007
Last updated
08/22/2020
Update your record
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