Provider Demographics
NPI:1275073538
Name:GREAT LAKES PHYSICAL THERAPY INC.
Entity Type:Organization
Organization Name:GREAT LAKES PHYSICAL THERAPY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TINA
Authorized Official - Middle Name:L
Authorized Official - Last Name:GRAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:219-765-8291
Mailing Address - Street 1:514 BEN DR
Mailing Address - Street 2:
Mailing Address - City:SCHERERVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46375-1260
Mailing Address - Country:US
Mailing Address - Phone:219-765-8291
Mailing Address - Fax:219-864-8594
Practice Address - Street 1:1129 MERRILLVILLE RD
Practice Address - Street 2:
Practice Address - City:CROWN POINT
Practice Address - State:IN
Practice Address - Zip Code:46307-2710
Practice Address - Country:US
Practice Address - Phone:219-661-8008
Practice Address - Fax:219-661-8998
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-06
Last Update Date:2017-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty