Provider Demographics
NPI:1326181488
Name:REHABILITATION SPECIALISTS OF MI
Entity Type:Organization
Organization Name:REHABILITATION SPECIALISTS OF MI
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO, PHYSICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:PUTVIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:810-923-2361
Mailing Address - Street 1:67965 VAN DYKE RD
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:MI
Mailing Address - Zip Code:48095-1468
Mailing Address - Country:US
Mailing Address - Phone:586-752-0500
Mailing Address - Fax:586-752-0504
Practice Address - Street 1:67965 VAN DYKE RD
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:MI
Practice Address - Zip Code:48095-1468
Practice Address - Country:US
Practice Address - Phone:586-752-0500
Practice Address - Fax:586-752-0504
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501001469225100000X
MI00078683235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Not Answered235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI236690Medicare ID - Type Unspecified