Provider Demographics
NPI:1912764127
Name:BMOR LLC
Entity Type:Organization
Organization Name:BMOR LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAYNE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:SZUKALOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:906-280-2995
Mailing Address - Street 1:3 HARBOR POINT LN
Mailing Address - Street 2:
Mailing Address - City:GLADSTONE
Mailing Address - State:MI
Mailing Address - Zip Code:49837-2771
Mailing Address - Country:US
Mailing Address - Phone:906-280-2995
Mailing Address - Fax:
Practice Address - Street 1:322 N LINCOLN RD
Practice Address - Street 2:
Practice Address - City:ESCANABA
Practice Address - State:MI
Practice Address - Zip Code:49829-1305
Practice Address - Country:US
Practice Address - Phone:906-553-7094
Practice Address - Fax:906-212-2046
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-04
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty