Provider Demographics
NPI:1154865046
Name:CENTRUM PHYSICAL THERAPY PC
Entity Type:Organization
Organization Name:CENTRUM PHYSICAL THERAPY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLER
Authorized Official - Prefix:MS
Authorized Official - First Name:CHELSEA
Authorized Official - Middle Name:LEEANN
Authorized Official - Last Name:ROLFE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:810-715-7746
Mailing Address - Street 1:1501 S CENTER RD
Mailing Address - Street 2:BUILDING A
Mailing Address - City:BURTON
Mailing Address - State:MI
Mailing Address - Zip Code:48509-1731
Mailing Address - Country:US
Mailing Address - Phone:810-715-7746
Mailing Address - Fax:810-715-7716
Practice Address - Street 1:1501 S CENTER RD
Practice Address - Street 2:BUILDING A
Practice Address - City:BURTON
Practice Address - State:MI
Practice Address - Zip Code:48509-1731
Practice Address - Country:US
Practice Address - Phone:810-715-7746
Practice Address - Fax:810-715-7716
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-12
Last Update Date:2016-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501006027261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy