Provider Demographics
NPI:1740617828
Name:BONE AND JOINT REHABILITATION CENTER, LLC
Entity Type:Organization
Organization Name:BONE AND JOINT REHABILITATION CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:J
Authorized Official - Last Name:FAUSONE
Authorized Official - Suffix:JR
Authorized Official - Credentials:DPT
Authorized Official - Phone:810-987-9711
Mailing Address - Street 1:600 FORT ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PORT HURON
Mailing Address - State:MI
Mailing Address - Zip Code:48060-3941
Mailing Address - Country:US
Mailing Address - Phone:810-987-9711
Mailing Address - Fax:810-987-6070
Practice Address - Street 1:33900 HARPER AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48035-4258
Practice Address - Country:US
Practice Address - Phone:586-416-9100
Practice Address - Fax:586-416-9103
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BONE & JOINT INSTITUTE PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-10-03
Last Update Date:2013-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty