Provider Demographics
NPI:1053360164
Name:RAMOS, EILEEN PALAD (PT)
Entity type:Individual
Prefix:
First Name:EILEEN
Middle Name:PALAD
Last Name:RAMOS
Suffix:
Gender:F
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:PO BOX 323
Mailing Address - Street 2:115 E. GRAND RIVER
Mailing Address - City:FOWLERVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48836-0323
Mailing Address - Country:US
Mailing Address - Phone:517-223-8308
Mailing Address - Fax:517-223-8344
Practice Address - Street 1:115 E. GRAND RIVER
Practice Address - Street 2:
Practice Address - City:FOWLERVILLE
Practice Address - State:MI
Practice Address - Zip Code:48836-0323
Practice Address - Country:US
Practice Address - Phone:517-223-8308
Practice Address - Fax:517-223-8344
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2007-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501009516225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIN93670014Medicare PIN