Provider Demographics
NPI:1669657383
Name:BONE & JOINT REHABILITATION CENTER
Entity Type:Organization
Organization Name:BONE & JOINT REHABILITATION CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING CLERK
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:L
Authorized Official - Last Name:MUNN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:810-987-9871
Mailing Address - Street 1:2611 ELECTRIC AVE
Mailing Address - Street 2:SUITE E
Mailing Address - City:PORT HURON
Mailing Address - State:MI
Mailing Address - Zip Code:48060-6587
Mailing Address - Country:US
Mailing Address - Phone:810-987-9871
Mailing Address - Fax:810-987-6070
Practice Address - Street 1:2611 ELECTRIC AVE
Practice Address - Street 2:SUITE E
Practice Address - City:PORT HURON
Practice Address - State:MI
Practice Address - Zip Code:48060-6587
Practice Address - Country:US
Practice Address - Phone:810-987-9871
Practice Address - Fax:810-987-6070
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BONE & JOINT INSTITUTE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-12-31
Last Update Date:2007-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIGJ050081225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty