Provider Demographics
NPI:1477555142
Name:P.T. SERVICES REHABILITATION, INC.
Entity Type:Organization
Organization Name:P.T. SERVICES REHABILITATION, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:TINA
Authorized Official - Middle Name:M
Authorized Official - Last Name:DEITEMEYER
Authorized Official - Suffix:
Authorized Official - Credentials:CCA
Authorized Official - Phone:419-447-7203
Mailing Address - Street 1:PO BOX 833
Mailing Address - Street 2:
Mailing Address - City:TIFFIN
Mailing Address - State:OH
Mailing Address - Zip Code:44883-0833
Mailing Address - Country:US
Mailing Address - Phone:419-447-7203
Mailing Address - Fax:419-447-5577
Practice Address - Street 1:15555 S TELEGRAPH RD
Practice Address - Street 2:SUITE 13
Practice Address - City:MONROE
Practice Address - State:MI
Practice Address - Zip Code:48161-4000
Practice Address - Country:US
Practice Address - Phone:419-447-7203
Practice Address - Fax:419-447-5577
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3032465Medicaid
MI=========OtherTAX ID