Provider Demographics
NPI:1083706584
Name:PHYSICAL THERAPY CENTER OF MIDLAND, LLC
Entity Type:Organization
Organization Name:PHYSICAL THERAPY CENTER OF MIDLAND, LLC
Other - Org Name:PHYISCAL THERAPY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MISS
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:ANNE-HALL
Authorized Official - Last Name:MCGUIRE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:989-839-9309
Mailing Address - Street 1:6105 JEFFERSON AVE
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48640-2935
Mailing Address - Country:US
Mailing Address - Phone:989-839-8309
Mailing Address - Fax:989-633-9170
Practice Address - Street 1:6105 JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48640-2935
Practice Address - Country:US
Practice Address - Phone:989-839-9309
Practice Address - Fax:989-633-9170
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-29
Last Update Date:2022-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501003922261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP36760001OtherMEDICARE PTAN