Provider Demographics
NPI:1972727212
Name:MILLENNIUM PT & REHAB SERVICES, PC
Entity Type:Organization
Organization Name:MILLENNIUM PT & REHAB SERVICES, PC
Other - Org Name:MILLENNIUM PHYSICAL THERAPY REHABILITATION AND WELLNESS.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:SUBHASIS
Authorized Official - Middle Name:
Authorized Official - Last Name:MOHANTY
Authorized Official - Suffix:
Authorized Official - Credentials:PT,DPT
Authorized Official - Phone:810-732-2252
Mailing Address - Street 1:5245 WEST PIERSON ROAD.
Mailing Address - Street 2:SUITE-2
Mailing Address - City:FLUSHING
Mailing Address - State:MI
Mailing Address - Zip Code:48433-3244
Mailing Address - Country:US
Mailing Address - Phone:810-732-2252
Mailing Address - Fax:810-732-4303
Practice Address - Street 1:5245 W PIERSON RD
Practice Address - Street 2:SUITE-2
Practice Address - City:FLUSHING
Practice Address - State:MI
Practice Address - Zip Code:48433-2411
Practice Address - Country:US
Practice Address - Phone:810-732-2252
Practice Address - Fax:810-732-4303
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2013-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501006170225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4501335Medicaid
MI650B557140OtherBCBS
MI4501335Medicaid