Provider Demographics
NPI:1467464206
Name:PHYSICAL THERAPY SERVICES OF CHELSEA, LLC
Entity Type:Organization
Organization Name:PHYSICAL THERAPY SERVICES OF CHELSEA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:LOU
Authorized Official - Last Name:CARRIER
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:269-372-8483
Mailing Address - Street 1:8682 WALLINWOOD FARMS AVE
Mailing Address - Street 2:
Mailing Address - City:JENISON
Mailing Address - State:MI
Mailing Address - Zip Code:49428-9419
Mailing Address - Country:US
Mailing Address - Phone:616-457-4891
Mailing Address - Fax:
Practice Address - Street 1:350 N MAIN ST
Practice Address - Street 2:
Practice Address - City:CHELSEA
Practice Address - State:MI
Practice Address - Zip Code:48118-1280
Practice Address - Country:US
Practice Address - Phone:734-277-2468
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-12
Last Update Date:2007-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501011355225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0P37690Medicare PIN