Provider Demographics
NPI:1528188703
Name:CROSWELL MANUAL THERAPY INC.
Entity Type:Organization
Organization Name:CROSWELL MANUAL THERAPY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:S
Authorized Official - Last Name:DEL ROSARIO
Authorized Official - Suffix:
Authorized Official - Credentials:RPT
Authorized Official - Phone:810-679-0078
Mailing Address - Street 1:51 BROWN ST
Mailing Address - Street 2:SUITE 5
Mailing Address - City:CROSWELL
Mailing Address - State:MI
Mailing Address - Zip Code:48422-1159
Mailing Address - Country:US
Mailing Address - Phone:810-679-0078
Mailing Address - Fax:810-679-4678
Practice Address - Street 1:51 BROWN ST
Practice Address - Street 2:SUITE 5
Practice Address - City:CROSWELL
Practice Address - State:MI
Practice Address - Zip Code:48422-1159
Practice Address - Country:US
Practice Address - Phone:810-679-0078
Practice Address - Fax:810-679-4678
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-30
Last Update Date:2008-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501007571225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0N97200OtherMEDICARE
MI650G610300OtherBCBS