Provider Demographics
NPI:1457403727
Name:NORTH SHORE PHYSICAL THERAPY BELLAIRE LLC
Entity Type:Organization
Organization Name:NORTH SHORE PHYSICAL THERAPY BELLAIRE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:
Authorized Official - Last Name:SUTHERLAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:231-533-6113
Mailing Address - Street 1:PO BOX 1020
Mailing Address - Street 2:
Mailing Address - City:BELLAIRE
Mailing Address - State:MI
Mailing Address - Zip Code:49615-1020
Mailing Address - Country:US
Mailing Address - Phone:231-533-6113
Mailing Address - Fax:231-533-5049
Practice Address - Street 1:102 S. BRIDGE ST.
Practice Address - Street 2:
Practice Address - City:BELLAIRE
Practice Address - State:MI
Practice Address - Zip Code:49615
Practice Address - Country:US
Practice Address - Phone:231-533-6113
Practice Address - Fax:231-533-5049
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-17
Last Update Date:2022-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501003806225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI20855OtherPRIORITY HEALTH
MI30611OtherBLUE CROSS BLUE SHIELD
MI4690420Medicaid
MI5963537OtherAETNA
MI4690420Medicaid