Provider Demographics
NPI:1225149305
Name:SAGINAW PHYSICAL THERAPY AND REHAB SPECIALISTS LLC
Entity Type:Organization
Organization Name:SAGINAW PHYSICAL THERAPY AND REHAB SPECIALISTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:P
Authorized Official - Last Name:PETERSON
Authorized Official - Suffix:
Authorized Official - Credentials:PT, MS
Authorized Official - Phone:989-992-1671
Mailing Address - Street 1:12 KINGSLEY CT
Mailing Address - Street 2:
Mailing Address - City:FRANKENMUTH
Mailing Address - State:MI
Mailing Address - Zip Code:48734-1270
Mailing Address - Country:US
Mailing Address - Phone:989-992-1671
Mailing Address - Fax:877-690-9097
Practice Address - Street 1:12729 E WASHINGTON RD
Practice Address - Street 2:STE 2
Practice Address - City:REESE
Practice Address - State:MI
Practice Address - Zip Code:48757-9722
Practice Address - Country:US
Practice Address - Phone:877-690-9096
Practice Address - Fax:877-690-9097
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2016-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501005682225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0N75080Medicare PIN