Provider Demographics
NPI:1871728816
Name:HULST JEPSEN PHYSICAL THERAPY
Entity type:Organization
Organization Name:HULST JEPSEN PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING SPECIALIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:JEANNETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:REISTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:616-281-1144
Mailing Address - Street 1:346 68TH ST SW
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49548-7179
Mailing Address - Country:US
Mailing Address - Phone:616-281-1144
Mailing Address - Fax:616-281-1221
Practice Address - Street 1:2120 43RD ST SE
Practice Address - Street 2:SUITE 100
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49508-3772
Practice Address - Country:US
Practice Address - Phone:616-281-1144
Practice Address - Fax:616-281-1221
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-20
Last Update Date:2009-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy