Provider Demographics
NPI:1104352087
Name:TRUMBULL & ASSOCIATES PHYSICAL THERAPY & SPINE PLLC
Entity type:Organization
Organization Name:TRUMBULL & ASSOCIATES PHYSICAL THERAPY & SPINE PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TOM
Authorized Official - Middle Name:KENNETH
Authorized Official - Last Name:TRUMBULL
Authorized Official - Suffix:IV
Authorized Official - Credentials:DPT
Authorized Official - Phone:616-200-4428
Mailing Address - Street 1:950 TAYLOR AVE
Mailing Address - Street 2:SUITE 180
Mailing Address - City:GRAND HAVEN
Mailing Address - State:MI
Mailing Address - Zip Code:49417-2282
Mailing Address - Country:US
Mailing Address - Phone:616-200-4428
Mailing Address - Fax:616-200-4436
Practice Address - Street 1:950 TAYLOR AVE
Practice Address - Street 2:SUITE 180
Practice Address - City:GRAND HAVEN
Practice Address - State:MI
Practice Address - Zip Code:49417-2282
Practice Address - Country:US
Practice Address - Phone:616-200-4428
Practice Address - Fax:616-200-4436
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-11
Last Update Date:2019-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy