Provider Demographics
NPI:1710261466
Name:MICHIGAN REHABILITATION SPECIALISTS OF DEXTER LLC
Entity Type:Organization
Organization Name:MICHIGAN REHABILITATION SPECIALISTS OF DEXTER LLC
Other - Org Name:MICHIGAN REHABILITATION SPECIALISTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:LINCOLN
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:810-231-6904
Mailing Address - Street 1:PO BOX 215
Mailing Address - Street 2:
Mailing Address - City:HAMBURG
Mailing Address - State:MI
Mailing Address - Zip Code:48139-0215
Mailing Address - Country:US
Mailing Address - Phone:810-231-6904
Mailing Address - Fax:810-231-6906
Practice Address - Street 1:2820 BAKER RD
Practice Address - Street 2:SUITE 201
Practice Address - City:DEXTER
Practice Address - State:MI
Practice Address - Zip Code:48130-1181
Practice Address - Country:US
Practice Address - Phone:734-424-9710
Practice Address - Fax:734-424-9711
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-29
Last Update Date:2012-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty