Provider Demographics
NPI:1487126744
Name:TICKLE, STEVEN H (PHYSICAL THER ASST)
Entity type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:H
Last Name:TICKLE
Suffix:
Gender:M
Credentials:PHYSICAL THER ASST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:1015 CHARLEVOIX DR
Mailing Address - Street 2:
Mailing Address - City:GRAND LEDGE
Mailing Address - State:MI
Mailing Address - Zip Code:48837-2278
Mailing Address - Country:US
Mailing Address - Phone:517-627-2885
Mailing Address - Fax:517-627-2599
Practice Address - Street 1:1015 CHARLEVOIX DR
Practice Address - Street 2:
Practice Address - City:GRAND LEDGE
Practice Address - State:MI
Practice Address - Zip Code:48837-2278
Practice Address - Country:US
Practice Address - Phone:517-627-2885
Practice Address - Fax:517-627-2599
Is Sole Proprietor?:No
Enumeration Date:2018-12-27
Last Update Date:2018-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5502002309225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant