Provider Demographics
NPI:1407060221
Name:HEALTHTRAK PHYSICAL THERAPY INC
Entity Type:Organization
Organization Name:HEALTHTRAK PHYSICAL THERAPY INC
Other - Org Name:HEALTHTRAK REHABILITATION SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:T
Authorized Official - Last Name:ECKHOUT
Authorized Official - Suffix:
Authorized Official - Credentials:RPT
Authorized Official - Phone:989-684-5009
Mailing Address - Street 1:903 N EUCLID AVE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:BAY CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48706-2478
Mailing Address - Country:US
Mailing Address - Phone:989-684-5009
Mailing Address - Fax:989-684-6929
Practice Address - Street 1:903 N EUCLID AVE
Practice Address - Street 2:SUITE 3
Practice Address - City:BAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48706-2478
Practice Address - Country:US
Practice Address - Phone:989-684-5009
Practice Address - Fax:989-684-6929
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2011-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI30649OtherBLUE CARE NETWORK PROV #
MI4784651Medicaid
MI4617396OtherAETNA PROVIDER NUMBER
MI0981311OtherHEALTHPLUS PROV #
MI30649OtherBLUE CROSS OF MI PROV#
MA1009815OtherMCLAREN PROVIDER NUMBER
MA1009815OtherMCLAREN PROVIDER NUMBER