Provider Demographics
NPI:1508980285
Name:PROFESSIONAL REHABILITATION SERVICES, INC.
Entity Type:Organization
Organization Name:PROFESSIONAL REHABILITATION SERVICES, INC.
Other - Org Name:REBOUND PHYSICAL THERAPY & OCCUPATIONAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:KRISTIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SKOGEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:616-202-4840
Mailing Address - Street 1:4234 CASCADE RD SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-8384
Mailing Address - Country:US
Mailing Address - Phone:616-202-4840
Mailing Address - Fax:888-371-9170
Practice Address - Street 1:2211 E BELTLINE AVE NE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49525-9802
Practice Address - Country:US
Practice Address - Phone:616-202-4840
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2021-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI30664OtherBLUE CROSS BLUESHEILD OF
MI1004061=========OtherHEALTH ADVANTAGE NETWORK
236711Medicare Oscar/Certification