| Organization Name: | GREAT LAKES PHYSICAL THERAPIES |
| NPI Number: | 1366688640 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JEFF A EATON (OWNER/PHYSICAL THERAPIST) |
| Mailing Address: | 2045 Holton Rd North Muskegon |
| State: | MI US |
| Postal Code: | 494451535 |
| Phone Number: | 2317440077 |
| Fax Number: | |
| NPI Enumeration Date: | 12/17/2008 |
| NPI Last Update Date: | 12/17/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QP2000X |
| License Number: | 5501011276 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MI |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Physical Therapy |
| Taxonomy Definition: | |