Provider Demographics
NPI:1710071360
Name:DEPHOUSE, LINK A (PT)
Entity type:Individual
Prefix:MR
First Name:LINK
Middle Name:A
Last Name:DEPHOUSE
Suffix:
Gender:M
Credentials:PT
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Mailing Address - Street 1:18000 COVE STREET
Mailing Address - Street 2:SUITE 202
Mailing Address - City:SPRING LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:49456-1383
Mailing Address - Country:US
Mailing Address - Phone:616-847-1280
Mailing Address - Fax:616-847-1290
Practice Address - Street 1:921 SOUTH BEECHTREE STREET
Practice Address - Street 2:SUITE 5
Practice Address - City:GRAND HAVEN
Practice Address - State:MI
Practice Address - Zip Code:49417-2385
Practice Address - Country:US
Practice Address - Phone:616-842-0555
Practice Address - Fax:616-842-0553
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2025-01-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI5501011546225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI382617193OtherTAX ID