Provider Demographics
NPI:1376775122
Name:PROFESSIONAL SPECTRUM INC
Entity Type:Organization
Organization Name:PROFESSIONAL SPECTRUM INC
Other - Org Name:MEDICAL PROFESSIONALS INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:VALENTINA
Authorized Official - Middle Name:M
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:810-600-0000
Mailing Address - Street 1:1055 CHARTER DR
Mailing Address - Street 2:SUITE 102
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532-3589
Mailing Address - Country:US
Mailing Address - Phone:810-600-0000
Mailing Address - Fax:810-600-0002
Practice Address - Street 1:1055 CHARTER DR
Practice Address - Street 2:SUITE 102
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-3589
Practice Address - Country:US
Practice Address - Phone:810-600-0000
Practice Address - Fax:810-600-0002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-12
Last Update Date:2009-08-12
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