Provider Demographics
NPI:1679669030
Name:PHYSICARE, INC
Entity Type:Organization
Organization Name:PHYSICARE, INC
Other - Org Name:ONAWAY PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LEONARD
Authorized Official - Middle Name:P
Authorized Official - Last Name:BERNARD
Authorized Official - Suffix:
Authorized Official - Credentials:RT
Authorized Official - Phone:989-733-9728
Mailing Address - Street 1:PO BOX 87
Mailing Address - Street 2:
Mailing Address - City:CADILLAC
Mailing Address - State:MI
Mailing Address - Zip Code:49601-0087
Mailing Address - Country:US
Mailing Address - Phone:231-775-6076
Mailing Address - Fax:231-775-0027
Practice Address - Street 1:4149 MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:ONAWAY
Practice Address - State:MI
Practice Address - Zip Code:49765-8852
Practice Address - Country:US
Practice Address - Phone:989-733-9728
Practice Address - Fax:989-733-9769
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2007-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0N87920Medicare ID - Type Unspecified