Provider Demographics
NPI:1487773099
Name:FOSSEN, ARTHUR H (PT)
Entity type:Individual
Prefix:
First Name:ARTHUR
Middle Name:H
Last Name:FOSSEN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1701 SOUTH BLVD E
Mailing Address - Street 2:SUITE 110
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48307-6122
Mailing Address - Country:US
Mailing Address - Phone:248-853-4431
Mailing Address - Fax:248-853-5048
Practice Address - Street 1:1701 SOUTH BLVD E
Practice Address - Street 2:SUITE 110
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48307-6122
Practice Address - Country:US
Practice Address - Phone:248-853-4431
Practice Address - Fax:248-853-5048
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2013-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501004940225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist