Provider Demographics
NPI:1720182058
Name:VP REHAB CARE INC.
Entity Type:Organization
Organization Name:VP REHAB CARE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:PASUPATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:VADIVELU
Authorized Official - Suffix:
Authorized Official - Credentials:BACHELORS DEGREE
Authorized Official - Phone:616-957-1300
Mailing Address - Street 1:1000 E PARIS AVE SE
Mailing Address - Street 2:SUITE 236
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-3691
Mailing Address - Country:US
Mailing Address - Phone:616-957-1300
Mailing Address - Fax:
Practice Address - Street 1:1000 E PARIS AVE SE
Practice Address - Street 2:SUITE 236
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-3691
Practice Address - Country:US
Practice Address - Phone:616-957-1300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501005841225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty