Provider Demographics
NPI:1205577061
Name:MICHIGAN PELVIC REHAB AND WELLNESS L.L.C.
Entity type:Organization
Organization Name:MICHIGAN PELVIC REHAB AND WELLNESS L.L.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LIA
Authorized Official - Middle Name:MAE
Authorized Official - Last Name:PALOMINO
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:231-388-3959
Mailing Address - Street 1:2506 CROSSING CIR STE B
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684-7955
Mailing Address - Country:US
Mailing Address - Phone:231-388-3959
Mailing Address - Fax:
Practice Address - Street 1:2506 CROSSING CIR STE B
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-7955
Practice Address - Country:US
Practice Address - Phone:231-388-3959
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-05
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy