Provider Demographics
NPI:1720465339
Name:MICHIGAN THERAPY CENTER
Entity Type:Organization
Organization Name:MICHIGAN THERAPY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BOB
Authorized Official - Middle Name:
Authorized Official - Last Name:BRESFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:517-332-4263
Mailing Address - Street 1:2111 MERRITT RD STE 101
Mailing Address - Street 2:
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48823-6916
Mailing Address - Country:US
Mailing Address - Phone:517-332-4263
Mailing Address - Fax:
Practice Address - Street 1:2111 MERRITT RD
Practice Address - Street 2:SUITE 101
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-6916
Practice Address - Country:US
Practice Address - Phone:517-332-4263
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-04
Last Update Date:2015-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201009030261QX0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational Medicine