Provider Demographics
NPI:1043358393
Name:MICHIGAN INSTITUTE OF REHABILITATIVE SERVICES, INC
Entity Type:Organization
Organization Name:MICHIGAN INSTITUTE OF REHABILITATIVE SERVICES, INC
Other - Org Name:AMERICAN PHYSICAL THERAPY & REHAB CENTER, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ALTERNATE ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:PARKER
Authorized Official - Suffix:
Authorized Official - Credentials:PTA
Authorized Official - Phone:989-826-6830
Mailing Address - Street 1:122 S. MORENCI AVENUE
Mailing Address - Street 2:
Mailing Address - City:MIO
Mailing Address - State:MI
Mailing Address - Zip Code:48647-2508
Mailing Address - Country:US
Mailing Address - Phone:989-826-6830
Mailing Address - Fax:989-826-6860
Practice Address - Street 1:122 S. MORENCI AVENUE
Practice Address - Street 2:
Practice Address - City:MIO
Practice Address - State:MI
Practice Address - Zip Code:48647-2508
Practice Address - Country:US
Practice Address - Phone:989-826-6830
Practice Address - Fax:989-826-6860
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-01
Last Update Date:2010-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI23-6686Medicare ID - Type UnspecifiedOPT