Provider Demographics
NPI:1982815908
Name:THERAPY BUILDERS RESOURCE GROUP, LLC
Entity Type:Organization
Organization Name:THERAPY BUILDERS RESOURCE GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:ALOYSIUS
Authorized Official - Last Name:MCKERNAN
Authorized Official - Suffix:
Authorized Official - Credentials:ESQUIRE
Authorized Official - Phone:269-488-8344
Mailing Address - Street 1:629 CAMPBELL AVE
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49006-3008
Mailing Address - Country:US
Mailing Address - Phone:269-488-8344
Mailing Address - Fax:269-488-2473
Practice Address - Street 1:629 CAMPBELL AVE
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49006-3008
Practice Address - Country:US
Practice Address - Phone:269-488-8344
Practice Address - Fax:269-488-2473
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty