| Organization Name: | LONGEVITY RESTORATIVE REHABILITATION SERVICES, LLC |
| NPI Number: | 1578796363 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JIMMIE JAMES ANTHONY (PRESIDENT) |
| Mailing Address: | 137 E Laketon Ave Muskegon |
| State: | MI US |
| Postal Code: | 494425507 |
| Phone Number: | 2317284102 |
| Fax Number: | 2317220800 |
| NPI Enumeration Date: | 08/27/2009 |
| NPI Last Update Date: | 10/06/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 225100000X |
| License Number: | 5501007594 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MI |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Physical Therapist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | (1) Physical therapists are health care professionals who evaluate and treat people with health problems resulting from injury or disease. PT |