Provider Demographics
NPI:1225105307
Name:BAY CITY PHYSICAL THERAPY INSTITUTE
Entity Type:Organization
Organization Name:BAY CITY PHYSICAL THERAPY INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:C
Authorized Official - Last Name:STEWART
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:989-894-1111
Mailing Address - Street 1:3941 TRAXLER CT
Mailing Address - Street 2:SUITE 400
Mailing Address - City:BAY CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48706-9600
Mailing Address - Country:US
Mailing Address - Phone:989-686-2419
Mailing Address - Fax:989-686-2942
Practice Address - Street 1:3941 TRAXLER CT
Practice Address - Street 2:SUITE 400
Practice Address - City:BAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48706-9600
Practice Address - Country:US
Practice Address - Phone:989-686-2419
Practice Address - Fax:989-686-2942
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-30
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0P00590Medicare PIN
MI0P14990Medicare PIN