Provider Demographics
NPI:1952499824
Name:BODY MECHANIX PHYSICAL THERAPY, LLC
Entity Type:Organization
Organization Name:BODY MECHANIX PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
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:906-483-4800
Mailing Address - Street 1:901 W SHARON AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:HOUGHTON
Mailing Address - State:MI
Mailing Address - Zip Code:49931-1964
Mailing Address - Country:US
Mailing Address - Phone:906-483-4800
Mailing Address - Fax:906-483-3972
Practice Address - Street 1:901 W SHARON AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:HOUGHTON
Practice Address - State:MI
Practice Address - Zip Code:49931-1964
Practice Address - Country:US
Practice Address - Phone:906-483-4800
Practice Address - Fax:906-483-3972
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-10
Last Update Date:2008-10-01
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
DD6320OtherRAILROAD MEDICARE
MI0N72240Medicare PIN
MI0P18780Medicare PIN
MI0N72240Medicare ID - Type Unspecified
MI0P36780Medicare PIN