Provider Demographics
NPI:1104857804
Name:FNI PHYSICAL MEDICINE & REHABILITATION, PC
Entity Type:Organization
Organization Name:FNI PHYSICAL MEDICINE & REHABILITATION, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:J
Authorized Official - Last Name:WIERSEMA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-797-3129
Mailing Address - Street 1:4677 TOWNE CENTRE RD STE 104
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48604-2847
Mailing Address - Country:US
Mailing Address - Phone:989-797-3129
Mailing Address - Fax:989-797-3106
Practice Address - Street 1:4677 TOWNE CENTRE RD STE 104
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48604-2847
Practice Address - Country:US
Practice Address - Phone:989-797-3129
Practice Address - Fax:989-797-3106
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0N17260Medicare ID - Type Unspecified