Provider Demographics
NPI:1689204703
Name:PROFESSIONAL ERGONOMICS LLC
Entity Type:Organization
Organization Name:PROFESSIONAL ERGONOMICS LLC
Other - Org Name:PROFESSIONAL ERGONOMICS THERAPY SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:A
Authorized Official - Last Name:GOODREAU
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:517-927-7220
Mailing Address - Street 1:228 CHURCH HILL DOWNS BLVD
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSTON
Mailing Address - State:MI
Mailing Address - Zip Code:48895-9053
Mailing Address - Country:US
Mailing Address - Phone:517-927-7220
Mailing Address - Fax:
Practice Address - Street 1:1754 CENTRAL PARK DR APT H
Practice Address - Street 2:
Practice Address - City:OKEMOS
Practice Address - State:MI
Practice Address - Zip Code:48864-1258
Practice Address - Country:US
Practice Address - Phone:517-349-4268
Practice Address - Fax:517-349-4298
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-16
Last Update Date:2020-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty