Basic Information
| Provider Information | |||||||||
| NPI: | 1295123586 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SAGINAW HORIZON PHYSICAL THERAPY AND REHABILITATION, PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4705 TOWNE CENTRE RD | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | SAGINAW | ||||||||
| State: | MI | ||||||||
| PostalCode: | 486042818 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9894015890 | ||||||||
| FaxNumber: | 9894015892 | ||||||||
| Practice Location | |||||||||
| Address1: | 4705 TOWNE CENTRE RD | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | SAGINAW | ||||||||
| State: | MI | ||||||||
| PostalCode: | 486042818 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9894015890 | ||||||||
| FaxNumber: | 9894015892 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/08/2015 | ||||||||
| LastUpdateDate: | 11/29/2016 | ||||||||
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| AuthorizedOfficialLastName: | CHALASANI | ||||||||
| AuthorizedOfficialFirstName: | KRISHNA | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT/ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 9894015890 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | PT | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QP2000X | E2848Q | MI | N | Ambulatory Health Care Facilities | Clinic/Center | Physical Therapy | 261QR0400X | Y | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation |
ID Information
| ID | Type | State | Issuer | Description | 1064831 | 01 | MI | HEALTH PLUS OF MICHIGAN | OTHER |