Provider Demographics
NPI:1265273247
Name:BEYOND REHABILITATION PLLC
Entity type:Organization
Organization Name:BEYOND REHABILITATION PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:JUDSON
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:248-765-7815
Mailing Address - Street 1:9103 BUSCH RD
Mailing Address - Street 2:
Mailing Address - City:BIRCH RUN
Mailing Address - State:MI
Mailing Address - Zip Code:48415-8441
Mailing Address - Country:US
Mailing Address - Phone:248-765-7815
Mailing Address - Fax:989-244-7907
Practice Address - Street 1:9103 BUSCH RD
Practice Address - Street 2:
Practice Address - City:BIRCH RUN
Practice Address - State:MI
Practice Address - Zip Code:48415-8441
Practice Address - Country:US
Practice Address - Phone:248-765-7815
Practice Address - Fax:989-244-7907
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-04
Last Update Date:2024-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy