Provider Demographics
NPI:1679965040
Name:BAY AREA PHYSICAL THERAPY, LLC
Entity type:Organization
Organization Name:BAY AREA PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:DIANNE
Authorized Official - Middle Name:L
Authorized Official - Last Name:ECKHOUT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-684-5009
Mailing Address - Street 1:903 N EUCLID AVE STE 3
Mailing Address - Street 2:
Mailing Address - City:BAY CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48706-2478
Mailing Address - Country:US
Mailing Address - Phone:989-684-5009
Mailing Address - Fax:
Practice Address - Street 1:903 N EUCLID AVE STE 3
Practice Address - Street 2:
Practice Address - City:BAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48706-2478
Practice Address - Country:US
Practice Address - Phone:989-684-5009
Practice Address - Fax:989-684-6929
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-23
Last Update Date:2015-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI55010019192251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty