Provider Demographics
NPI:1528248200
Name:LIVING HOPE PHYSICAL THERAPY, L.L.C.
Entity type:Organization
Organization Name:LIVING HOPE PHYSICAL THERAPY, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:AARON
Authorized Official - Last Name:DOUBBLESTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:231-652-8140
Mailing Address - Street 1:PO BOX 474
Mailing Address - Street 2:
Mailing Address - City:NEWAYGO
Mailing Address - State:MI
Mailing Address - Zip Code:49337-0474
Mailing Address - Country:US
Mailing Address - Phone:231-652-8140
Mailing Address - Fax:231-652-8141
Practice Address - Street 1:8847 MASON DR
Practice Address - Street 2:
Practice Address - City:NEWAYGO
Practice Address - State:MI
Practice Address - Zip Code:49337-8815
Practice Address - Country:US
Practice Address - Phone:231-652-8140
Practice Address - Fax:231-652-8141
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-09
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501009001225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4750869Medicaid
MI=========OtherPRIORITY HEALTH
MI4750869Medicaid
OP14980Medicare PIN