FUEL PHYSICAL THERAPY & SPORTS PERFORMANCE, LLC (NPI# 1063980373) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1063980373 |
Entity Type | Organization |
Organization Name | FUEL PHYSICAL THERAPY & SPORTS PERFORMANCE, LLC |
Practice Address |
1139 Houseman Ave Ne Grand Rapids MI 49503-1229 |
Practice Telephone | 8103475219 |
Practice Fax Number | 6162594226 |
Mailing Telephone | 8103475219 |
Enumeration Date | 2018-11-05 |
Last Update Date | 2018-11-05 |
Authorized Official Name | ERIC SCOTT BROADWORTH (OWNER/PHYSICAL THERAPIST) |
Authorized Official Telephone | 8103475219 |
Authorized Official Credential | DPT |
Is Organization Subpart | N |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
N | 2251X0800X |
Physical Therapist Specialization: Orthopedic |
Respiratory, Developmental, Rehabilitative and Restorative Service Providers | ||
Y | 261QP2000X |
Clinic/Center Specialization: Physical Therapy |
Ambulatory Health Care Facilities |
Street Address |
1139 HOUSEMAN AVE NE |
City | GRAND RAPIDS |
State | MI |
Zip Code | 49503-1229 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1801496195 | Airway Oxygen, Inc. | Durable Medical Equipment & Medical Supplies | Lemmen Holton Cancer Pavilion, 145 Michigan St Ne Ste 3400, Grand Rapids, MI 49503 | 2020-10-27 |
1730707282 | Adriana Molina-schmuker | Counselor | 901 Eastern Avenue Ne, Grand Rapids, MI 49503 | 2020-07-10 |
1477176949 | Kimberly Buskirk | Specialist | 1131 Ionia Ava Nw, Grand Rapids, MI 49503 | 2020-05-19 |
1124647805 | Jared Host | Speech-Language Pathologist | Mercy Health Hauenstein Neuroscience Center 220 Cherry, Grand Rapids, MI 49503 | 2020-04-13 |
1265061378 | Heather Gladfelter | Student in an Organized Health Care Education/Training Program | 339 Barclay Ave Ne Ste 300, Grand Rapids, MI 49503 | 2020-04-02 |
1194368647 | Amy Jo Arends | Nurse Practitioner | 350 Lafayette S.e., Suite 301, Grand Rapids, MI 49503 | 2019-10-28 |
1376185199 | Beth Arce | Occupational Therapist | 245 Cherry St Se Suite 302, Grand Rapids, MI 49503 | 2019-10-14 |
1295387256 | Althea Ziolkowski | Licensed Practical Nurse | Salvation Army Turning Point Programs, 1215 Fulton St E, Grand Rapids, MI 49503 | 2019-07-10 |
1790340719 | Heather Anne Fox | Occupational Therapist | Marywood, 111 Lakeside Dr Ne, Grand Rapids, MI 49503 | 2019-05-06 |
1184182883 | April L Kaiserlian | Social Worker | 983 Spaulding Ave Ne, Ada, MI 49503 | 2019-03-12 |
Find all providers in zip 49503 |
Taxonomy Code | 261QP2000X |
Grouping | Ambulatory Health Care Facilities |
Classification | Clinic/Center |
Specialization | Physical Therapy |
Definition to come... |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1821362278 | Primary Rehab Center LLC | Clinic/Center | 2055 28th St Se Ste 7, Grand Rapids, MI 49508 | 2012-03-02 |
1417183971 | Agility Health Rehabilitation LLC | Clinic/Center | 607 Dewey Ave Nw, Suite 300, Grand Rapids, MI 49504-7335 | 2009-06-10 |
1386739738 | Physiotherapy Associates Inc | Clinic/Center | 515 Michigan St Ne, Grand Rapids, MI 49503-5721 | 2006-10-03 |
1346719234 | Dynamic Movement and Recovery | Clinic/Center | 4950 Plainfield Ave Ne Ste A, Grand Rapids, MI 49525-1059 | 2018-11-20 |
1902288863 | Center for Physical Rehabilitation and Therapy Lp | Clinic/Center | 5060 Cascade Rd Se, Suite A, Grand Rapids, MI 49546-3808 | 2015-06-26 |
1598169682 | Good Life Therapy LLC | Clinic/Center | 1331 Lake Dr Se, Suite 105, Grand Rapids, MI 49506-1674 | 2014-10-17 |
1811313612 | Alans Physical Therapy of Grand Rapids | Clinic/Center | 111 Golf Course Rd, Suite 2, Grand Rapids, MN 55744-3526 | 2014-03-17 |
1295098945 | In Home Therapy of Grand Rapids, LLC | Clinic/Center | 2433 Valentine Blvd Ne, Grand Rapids, MI 49525-3070 | 2012-06-18 |
1508130147 | Patti Kampa Physical Therapy | Clinic/Center | 15 Ne 5th St, Grand Rapids, MN 55744-2760 | 2012-02-29 |
1871728816 | Hulst Jepsen Physical Therapy | Clinic/Center | 2120 43rd St Se, Suite 100, Grand Rapids, MI 49508-3772 | 2009-05-20 |
Find all providers in GRAND RAPIDS |
City | GRAND RAPIDS |
Zip Code | 49503 |
Please comment or provide details below to improve the information on FUEL PHYSICAL THERAPY & SPORTS PERFORMANCE, LLC.
Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.