Provider Demographics
NPI:1023115201
Name:MICHIGAN INSTITUTE FOR HUMAN PERFORMANCE INC
Entity type:Organization
Organization Name:MICHIGAN INSTITUTE FOR HUMAN PERFORMANCE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHERRY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:MCLAUGHLIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-269-0230
Mailing Address - Street 1:2265 LIVERNOIS RD
Mailing Address - Street 2:SUITE 700
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48083-1633
Mailing Address - Country:US
Mailing Address - Phone:248-269-0230
Mailing Address - Fax:248-269-0231
Practice Address - Street 1:2265 LIVERNOIS RD
Practice Address - Street 2:SUITE 700
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48083-1633
Practice Address - Country:US
Practice Address - Phone:248-269-0230
Practice Address - Fax:248-269-0231
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2011-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501004256225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI650F397060OtherBLUE CROSS
0P09750Medicare ID - Type Unspecified
MI650F397060OtherBLUE CROSS