Provider Demographics
NPI:1982386504
Name:MUNGER PHYSICAL THERAPY OF MARYSVILLE, PLC
Entity Type:Organization
Organization Name:MUNGER PHYSICAL THERAPY OF MARYSVILLE, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JUDY
Authorized Official - Middle Name:
Authorized Official - Last Name:BLAKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:810-385-7405
Mailing Address - Street 1:4351 24TH AVE STE 5
Mailing Address - Street 2:
Mailing Address - City:FORT GRATIOT
Mailing Address - State:MI
Mailing Address - Zip Code:48059-4506
Mailing Address - Country:US
Mailing Address - Phone:810-385-7405
Mailing Address - Fax:810-385-7420
Practice Address - Street 1:782 HURON BLVD STE 4
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:MI
Practice Address - Zip Code:48040-1499
Practice Address - Country:US
Practice Address - Phone:810-385-7405
Practice Address - Fax:810-385-7420
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-03
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty