Provider Demographics
NPI:1730683426
Name:BESAW, CORRIE (PT)
Entity type:Individual
Prefix:
First Name:CORRIE
Middle Name:
Last Name:BESAW
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1837 FRASER RD
Mailing Address - Street 2:
Mailing Address - City:KAWKAWLIN
Mailing Address - State:MI
Mailing Address - Zip Code:48631-9475
Mailing Address - Country:US
Mailing Address - Phone:989-225-1776
Mailing Address - Fax:
Practice Address - Street 1:1395 S HURON RD
Practice Address - Street 2:
Practice Address - City:KAWKAWLIN
Practice Address - State:MI
Practice Address - Zip Code:48631-9485
Practice Address - Country:US
Practice Address - Phone:989-686-5196
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-19
Last Update Date:2018-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501011219225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist