Provider Demographics
NPI:1902977788
Name:HUDSONVILLE PHYSICAL THERAPY, INC.
Entity Type:Organization
Organization Name:HUDSONVILLE PHYSICAL THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:R
Authorized Official - Last Name:BARTZ
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:616-662-0990
Mailing Address - Street 1:3152 PORT SHELDON ST STE A
Mailing Address - Street 2:
Mailing Address - City:HUDSONVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49426-9297
Mailing Address - Country:US
Mailing Address - Phone:616-662-0990
Mailing Address - Fax:616-662-0992
Practice Address - Street 1:3152 PORT SHELDON ST STE A
Practice Address - Street 2:
Practice Address - City:HUDSONVILLE
Practice Address - State:MI
Practice Address - Zip Code:49426-9297
Practice Address - Country:US
Practice Address - Phone:616-662-0990
Practice Address - Fax:616-662-0992
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI30685OtherBCBS
MI30685OtherBCBS