Provider Demographics
NPI:1942398821
Name:BODY MECHANIX PHYSICAL THERAPY OF ESCANABA, LLC
Entity Type:Organization
Organization Name:BODY MECHANIX PHYSICAL THERAPY OF ESCANABA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CLARENCE
Authorized Official - Middle Name:KELLY
Authorized Official - Last Name:HRABINSKY
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:906-370-5355
Mailing Address - Street 1:49253 STATE HIGHWAY M26
Mailing Address - Street 2:
Mailing Address - City:HANCOCK
Mailing Address - State:MI
Mailing Address - Zip Code:49930-9331
Mailing Address - Country:US
Mailing Address - Phone:906-370-5355
Mailing Address - Fax:906-337-3869
Practice Address - Street 1:901 SOUTH LINCOLN ROAD
Practice Address - Street 2:SUITE B
Practice Address - City:ESCANABA
Practice Address - State:MI
Practice Address - Zip Code:49829
Practice Address - Country:US
Practice Address - Phone:906-370-5355
Practice Address - Fax:906-789-1500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-10
Last Update Date:2014-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI650B110390OtherBLUE CROSS BLUE SHIELD
MI650B110390OtherBLUE CROSS BLUE SHIELD
MIP36780001Medicare PIN