Provider Demographics
NPI:1013044569
Name:THERASPORT PHYSICAL THERAPY, INC.
Entity Type:Organization
Organization Name:THERASPORT PHYSICAL THERAPY, INC.
Other - Org Name:HEARTLAND REHABILITATION SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT - REIMBURSEMENTS
Authorized Official - Prefix:MR
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:A
Authorized Official - Last Name:LAZARUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-252-5541
Mailing Address - Street 1:3425 EXECUTIVE PKWY
Mailing Address - Street 2:SUITE 128
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43606-1326
Mailing Address - Country:US
Mailing Address - Phone:419-252-5541
Mailing Address - Fax:419-252-5548
Practice Address - Street 1:6543 MIDDLEBELT RD
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:MI
Practice Address - Zip Code:48135-2145
Practice Address - Country:US
Practice Address - Phone:734-458-7878
Practice Address - Fax:734-458-7838
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4838850Medicaid
MI4838850Medicaid