Provider Demographics
NPI:1679598452
Name:THERAPY SPECIALISTS, INC.
Entity Type:Organization
Organization Name:THERAPY SPECIALISTS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:LEO
Authorized Official - Last Name:STRATTON
Authorized Official - Suffix:
Authorized Official - Credentials:MHSPT
Authorized Official - Phone:616-292-6736
Mailing Address - Street 1:1444 MICHIGAN ST NE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-2028
Mailing Address - Country:US
Mailing Address - Phone:616-292-6736
Mailing Address - Fax:616-774-0961
Practice Address - Street 1:1444 MICHIGAN ST NE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-2028
Practice Address - Country:US
Practice Address - Phone:616-292-6736
Practice Address - Fax:616-774-0961
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-13
Last Update Date:2013-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501004057225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI650D157400OtherBLUE CROSS BLUE SHIELD
MI0M90850Medicare PIN
MIOM90850Medicare ID - Type Unspecified
MIS933474Medicare UPIN