Provider Demographics
NPI:1780711861
Name:REHABILITATION SPECIALISTS OF LIVINGSTON COUNTY, INC.
Entity type:Organization
Organization Name:REHABILITATION SPECIALISTS OF LIVINGSTON COUNTY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO, PHYSICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:PUTVIN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:810-923-2361
Mailing Address - Street 1:27427 SCHOENHERR RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48088-4729
Mailing Address - Country:US
Mailing Address - Phone:586-757-9311
Mailing Address - Fax:586-757-9401
Practice Address - Street 1:27427 SCHOENHERR RD
Practice Address - Street 2:SUITE 200
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48088-4729
Practice Address - Country:US
Practice Address - Phone:586-757-9311
Practice Address - Fax:586-757-9401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2007-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI00078683235Z00000X
MI5501001469225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI30638OtherBCBSM
MI236784Medicare ID - Type Unspecified