Provider Demographics
NPI:1700212479
Name:FAMILY FITNESS AND REHABILITATION, LLC
Entity Type:Organization
Organization Name:FAMILY FITNESS AND REHABILITATION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RESIDENT AGENT
Authorized Official - Prefix:
Authorized Official - First Name:BECKY
Authorized Official - Middle Name:L
Authorized Official - Last Name:SULLIVAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-826-6830
Mailing Address - Street 1:122 S MORENCI AVE STE A
Mailing Address - Street 2:P.O. BOX 1032
Mailing Address - City:MIO
Mailing Address - State:MI
Mailing Address - Zip Code:48647-2508
Mailing Address - Country:US
Mailing Address - Phone:989-826-6830
Mailing Address - Fax:989-826-6860
Practice Address - Street 1:122 S MORENCI AVE STE A
Practice Address - Street 2:
Practice Address - City:MIO
Practice Address - State:MI
Practice Address - Zip Code:48647-2508
Practice Address - Country:US
Practice Address - Phone:989-826-6830
Practice Address - Fax:989-826-6860
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-25
Last Update Date:2013-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy