Provider Demographics
NPI:1780775809
Name:CENTRAL MICHIGAN REHABILITATION, LLC
Entity type:Organization
Organization Name:CENTRAL MICHIGAN REHABILITATION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC DIRECTOR/PT
Authorized Official - Prefix:MR
Authorized Official - First Name:MANISH
Authorized Official - Middle Name:
Authorized Official - Last Name:BONDALE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:989-772-0258
Mailing Address - Street 1:1500 W. HIGH STREET
Mailing Address - Street 2:
Mailing Address - City:MT. PLEASANT
Mailing Address - State:MI
Mailing Address - Zip Code:48858
Mailing Address - Country:US
Mailing Address - Phone:989-772-0258
Mailing Address - Fax:989-953-4603
Practice Address - Street 1:1500 W. HIGH STREET
Practice Address - Street 2:
Practice Address - City:MT. PLEASANT
Practice Address - State:MI
Practice Address - Zip Code:48858
Practice Address - Country:US
Practice Address - Phone:989-772-0258
Practice Address - Fax:989-953-4603
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-27
Last Update Date:2010-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501009360225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
30069OtherBCBSM
MI404983397Medicaid
MI4877G07Medicaid
MI00710460OtherBLUE CROSS
MI404983397Medicaid
MI4877G07Medicaid