Provider Demographics
NPI:1285645358
Name:BEDFORD PHYSICAL THERAPY PC
Entity Type:Organization
Organization Name:BEDFORD PHYSICAL THERAPY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:H
Authorized Official - Last Name:DWIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:248-866-4364
Mailing Address - Street 1:42615 GARFIELD
Mailing Address - Street 2:
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48038
Mailing Address - Country:US
Mailing Address - Phone:586-412-2846
Mailing Address - Fax:586-286-0427
Practice Address - Street 1:7300 SECOR RD
Practice Address - Street 2:STE 3
Practice Address - City:LAMBERTVILLE
Practice Address - State:MI
Practice Address - Zip Code:48144
Practice Address - Country:US
Practice Address - Phone:734-854-1260
Practice Address - Fax:734-854-3581
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-11
Last Update Date:2008-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI30363OtherBC
MI236518Medicare Oscar/Certification