Provider Demographics
NPI:1235181751
Name:ORTHOPAEDIC THERAPY, INC.
Entity Type:Organization
Organization Name:ORTHOPAEDIC THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:BEISSEL
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:517-787-2739
Mailing Address - Street 1:PO BOX 1447
Mailing Address - Street 2:728 W FRANKLIN STREET
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49204-1447
Mailing Address - Country:US
Mailing Address - Phone:517-783-2739
Mailing Address - Fax:517-783-6450
Practice Address - Street 1:728 W FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49201-2008
Practice Address - Country:US
Practice Address - Phone:517-783-2739
Practice Address - Fax:517-783-6450
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-16
Last Update Date:2020-08-22
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
MI0C85701OtherBCBS
MI0C85701OtherBCBS