Provider Demographics
NPI:1528010410
Name:UNIQUE REHABILITATION SERVICES INC.
Entity Type:Organization
Organization Name:UNIQUE REHABILITATION SERVICES INC.
Other - Org Name:URBANDALE PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:O
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:269-565-1080
Mailing Address - Street 1:1525 W MICHIGAN
Mailing Address - Street 2:PO BOX 1442
Mailing Address - City:BATTLE CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:49017
Mailing Address - Country:US
Mailing Address - Phone:269-565-1080
Mailing Address - Fax:269-565-1082
Practice Address - Street 1:1525 W MICHIGAN
Practice Address - Street 2:
Practice Address - City:BATTLE CREEK
Practice Address - State:MI
Practice Address - Zip Code:49017
Practice Address - Country:US
Practice Address - Phone:269-565-1080
Practice Address - Fax:269-565-1082
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-17
Last Update Date:2018-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501006847225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4461070Medicaid
MI4461070Medicaid
N84870001Medicare ID - Type Unspecified