Provider Demographics
NPI:1710995246
Name:ORTHOSPORT PHYSICAL THERAPY AND ATHLETIC REHABILITATION INC.
Entity Type:Organization
Organization Name:ORTHOSPORT PHYSICAL THERAPY AND ATHLETIC REHABILITATION INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:AUGUST
Authorized Official - Last Name:BUDNICK
Authorized Official - Suffix:
Authorized Official - Credentials:MPT,OCS
Authorized Official - Phone:231-348-1011
Mailing Address - Street 1:2230 E MITCHELL RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:PETOSKEY
Mailing Address - State:MI
Mailing Address - Zip Code:49770-6601
Mailing Address - Country:US
Mailing Address - Phone:231-348-1011
Mailing Address - Fax:231-348-6998
Practice Address - Street 1:2230 E MITCHELL RD
Practice Address - Street 2:SUITE B
Practice Address - City:PETOSKEY
Practice Address - State:MI
Practice Address - Zip Code:49770-6601
Practice Address - Country:US
Practice Address - Phone:231-348-1011
Practice Address - Fax:231-348-6998
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI55010084492251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0P16730Medicare ID - Type Unspecified