Provider Demographics
NPI:1437273877
Name:NORTHWOODS REHABILITATION INC.
Entity Type:Organization
Organization Name:NORTHWOODS REHABILITATION INC.
Other - Org Name:GLADSTONE PHYSICAL THERAPY & WELLNESS CENTER
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HOWES
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:906-428-3085
Mailing Address - Street 1:2001 MINNEAPOLIS AVE. SUITE C
Mailing Address - Street 2:
Mailing Address - City:GLADSTONE
Mailing Address - State:MI
Mailing Address - Zip Code:49837
Mailing Address - Country:US
Mailing Address - Phone:906-428-3085
Mailing Address - Fax:906-428-3086
Practice Address - Street 1:2001 MINNEAPOLIS AVE SUITE C
Practice Address - Street 2:
Practice Address - City:GLADSTONE
Practice Address - State:MI
Practice Address - Zip Code:49837
Practice Address - Country:US
Practice Address - Phone:906-428-3085
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2011-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOP14400Medicare PIN