Provider Demographics
NPI:1073693479
Name:SPECTRUM DEVELOPMENT CORPORATION
Entity Type:Organization
Organization Name:SPECTRUM DEVELOPMENT CORPORATION
Other - Org Name:CORE THERAPEUTICS & REHABILITATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT.
Authorized Official - Prefix:MS
Authorized Official - First Name:CHERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:CATRAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-557-2154
Mailing Address - Street 1:34514 DEQUINDRE ROAD
Mailing Address - Street 2:SUITE A
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48310-1701
Mailing Address - Country:US
Mailing Address - Phone:248-557-2154
Mailing Address - Fax:248-557-0613
Practice Address - Street 1:34514-DEQUINDRE ROAD
Practice Address - Street 2:SUITE A
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48310-1701
Practice Address - Country:US
Practice Address - Phone:248-557-2154
Practice Address - Fax:248-557-0613
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2021-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI261QP2000X, 261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI236656Medicare Oscar/Certification