Provider Demographics
NPI:1700073376
Name:BODY MECHANIX PHYSICAL THERAPY, LLC
Entity Type:Organization
Organization Name:BODY MECHANIX PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PT
Authorized Official - Prefix:MR
Authorized Official - First Name:CLARENCE
Authorized Official - Middle Name:KELLY
Authorized Official - Last Name:HRABINSKY
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:906-370-5355
Mailing Address - Street 1:49253 STATE HIGHWAY M26
Mailing Address - Street 2:
Mailing Address - City:HANCOCK
Mailing Address - State:MI
Mailing Address - Zip Code:49930-9331
Mailing Address - Country:US
Mailing Address - Phone:906-370-5355
Mailing Address - Fax:
Practice Address - Street 1:56730 CALUMET AVENUE
Practice Address - Street 2:SUITE M
Practice Address - City:CALUMET
Practice Address - State:MI
Practice Address - Zip Code:49913
Practice Address - Country:US
Practice Address - Phone:906-337-1100
Practice Address - Fax:906-337-3869
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-27
Last Update Date:2014-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501006289225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI104565600Medicaid
MI104565600Medicaid
MI0N72240Medicare PIN