Provider Demographics
NPI:1417380569
Name:VESTIBULAR REHAB INSTITUTE OF MICHIGAN
Entity Type:Organization
Organization Name:VESTIBULAR REHAB INSTITUTE OF MICHIGAN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:BEJOICE
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:248-855-1154
Mailing Address - Street 1:6014 W MAPLE RD STE B
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322-2212
Mailing Address - Country:US
Mailing Address - Phone:248-855-1154
Mailing Address - Fax:248-855-7458
Practice Address - Street 1:6014 W MAPLE RD STE B
Practice Address - Street 2:
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48322-2212
Practice Address - Country:US
Practice Address - Phone:248-855-1154
Practice Address - Fax:248-855-7458
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-13
Last Update Date:2016-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501009768225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0H70870OtherBCBSM
MI0H70870OtherBCBSM