Provider Demographics
NPI:1790752004
Name:PHYSICAL THERAPY ASSOCIATES OF KALAMAZOO, PC
Entity Type:Organization
Organization Name:PHYSICAL THERAPY ASSOCIATES OF KALAMAZOO, PC
Other - Org Name:REHABILITATION WORKS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:RACHAEL
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:STNEDER-PATRICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:269-343-7100
Mailing Address - Street 1:303 BALCH STREET
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49001
Mailing Address - Country:US
Mailing Address - Phone:269-343-7100
Mailing Address - Fax:269-343-1330
Practice Address - Street 1:303 BALCH STREET
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49001
Practice Address - Country:US
Practice Address - Phone:269-343-7100
Practice Address - Fax:269-343-1330
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Not Answered225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
Not Answered235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI30621OtherBLUE CROSS BLUE SHIELD
MI4670035OtherAETNA
MI4737615Medicaid
MI4737615Medicaid