Provider Demographics
NPI:1578572608
Name:MISSION PHYSICAL THERAPY, INC
Entity Type:Organization
Organization Name:MISSION PHYSICAL THERAPY, INC
Other - Org Name:NUSTEP PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER-R.P.T.
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:AHMED
Authorized Official - Last Name:SAKALA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-772-5800
Mailing Address - Street 1:555 S MISSION ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:MT PLEASANT
Mailing Address - State:MI
Mailing Address - Zip Code:48858-2846
Mailing Address - Country:US
Mailing Address - Phone:989-772-5800
Mailing Address - Fax:989-772-4342
Practice Address - Street 1:555 S MISSION ST
Practice Address - Street 2:SUITE A
Practice Address - City:MT PLEASANT
Practice Address - State:MI
Practice Address - Zip Code:48858-2846
Practice Address - Country:US
Practice Address - Phone:989-772-5800
Practice Address - Fax:989-772-4342
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-07
Last Update Date:2013-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QP2000X
MI261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI30474OtherBCBSM
MI900021648OtherPRIORITY HEALTH
MI30474OtherBLUE CROSS BLUE SHIELD
MI104613144Medicaid
MI104613144Medicaid
MI30474OtherBLUE CROSS BLUE SHIELD