Provider Demographics
NPI:1932307022
Name:NORTHWOODS REHABILITATION INC.
Entity Type:Organization
Organization Name:NORTHWOODS REHABILITATION INC.
Other - Org Name:GLADSTONE PHYSICAL THERAPY & WELLNESS CENER
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HOWES
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:906-428-3085
Mailing Address - Street 1:2845 US HIGHWAY 2/41
Mailing Address - Street 2:
Mailing Address - City:BARK RIVER
Mailing Address - State:MI
Mailing Address - Zip Code:49807-9791
Mailing Address - Country:US
Mailing Address - Phone:906-466-2090
Mailing Address - Fax:
Practice Address - Street 1:2845 US HIGHWAY 2/41
Practice Address - Street 2:
Practice Address - City:BARK RIVER
Practice Address - State:MI
Practice Address - Zip Code:49807-9791
Practice Address - Country:US
Practice Address - Phone:906-466-2090
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-10
Last Update Date:2007-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501011535261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOB11028OtherBCBS
MIOB11028OtherBCBS