Provider Demographics
NPI:1578716379
Name:THE FAMILY PRACTICE AND ORTHOPEDIC CARE CENTER PLLC
Entity Type:Organization
Organization Name:THE FAMILY PRACTICE AND ORTHOPEDIC CARE CENTER PLLC
Other - Org Name:OMEGA PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:HARTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:517-279-9599
Mailing Address - Street 1:410 N WILLOWBROOK ROAD
Mailing Address - Street 2:SUITE A
Mailing Address - City:COLDWATER
Mailing Address - State:MI
Mailing Address - Zip Code:49036
Mailing Address - Country:US
Mailing Address - Phone:517-279-9599
Mailing Address - Fax:
Practice Address - Street 1:410 N WILLOWBROOK ROAD
Practice Address - Street 2:SUITE A
Practice Address - City:COLDWATER
Practice Address - State:MI
Practice Address - Zip Code:49036
Practice Address - Country:US
Practice Address - Phone:517-279-9599
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-24
Last Update Date:2008-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101014488207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty