Provider Demographics
NPI:1467719252
Name:MICHIGAN PHYSICAL THERAPY, INC.
Entity Type:Organization
Organization Name:MICHIGAN PHYSICAL THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:PARKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-390-3718
Mailing Address - Street 1:PO BOX 1032
Mailing Address - Street 2:
Mailing Address - City:MIO
Mailing Address - State:MI
Mailing Address - Zip Code:48647-1032
Mailing Address - Country:US
Mailing Address - Phone:989-826-6830
Mailing Address - Fax:989-826-6860
Practice Address - Street 1:124 SOUTH MORENCI STREET
Practice Address - Street 2:
Practice Address - City:MIO
Practice Address - State:MI
Practice Address - Zip Code:48647-1032
Practice Address - Country:US
Practice Address - Phone:989-390-3718
Practice Address - Fax:989-826-6860
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-18
Last Update Date:2015-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI236860Medicare Oscar/Certification