Provider Demographics
NPI:1043080716
Name:BEDFORD, HOUSTON (DPT)
Entity type:Individual
Prefix:DR
First Name:HOUSTON
Middle Name:
Last Name:BEDFORD
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
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:2024-01-04
Last Update Date:2025-01-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI5501303091225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist