Basic Information
Provider Information
NPI: 1023117876
EntityType: 2
ReplacementNPI:  
OrganizationName: MUSCLE & SPINE REHABILITATION CENTER LLC
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 3480 CAPITAL AVE SW
Address2:  
City: BATTLE CREEK
State: MI
PostalCode: 490159354
CountryCode: US
TelephoneNumber: 2699793000
FaxNumber: 2699799770
Practice Location
Address1: 3480 CAPITAL AVE SW
Address2:  
City: BATTLE CREEK
State: MI
PostalCode: 490159354
CountryCode: US
TelephoneNumber: 2699793000
FaxNumber: 2699799770
Other Information
ProviderEnumerationDate: 09/21/2006
LastUpdateDate: 08/20/2014
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: ESSEX
AuthorizedOfficialFirstName: ROBERT
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition: PRESIDENT
AuthorizedOfficialTelephone: 2699793000
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix: MR.
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential: PT, MS, DPT, OCS
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
261QP2000X5501004323-PT/MIMIY Ambulatory Health Care FacilitiesClinic/CenterPhysical Therapy

No ID Information.


Home