Provider Demographics
NPI:1750619409
Name:PHYSICAL COGNITIVE NETWORK, INC.
Entity type:Organization
Organization Name:PHYSICAL COGNITIVE NETWORK, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE OWNER AND MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:E
Authorized Official - Last Name:BEALE
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:586-552-1525
Mailing Address - Street 1:28550 SCHOENHERR RD
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48088-4329
Mailing Address - Country:US
Mailing Address - Phone:586-552-1562
Mailing Address - Fax:586-552-1535
Practice Address - Street 1:28550 SCHOENHERR RD
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48088-4329
Practice Address - Country:US
Practice Address - Phone:586-552-1562
Practice Address - Fax:586-552-1535
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-18
Last Update Date:2009-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI035963261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1663001Medicare PIN