Basic Information
| Provider Information | |||||||||
| NPI: | 1508013376 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MICHIGAN REHABILITATION SPECIALISTS HOUSE CALLS, P.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 215 | ||||||||
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| City: | HAMBURG | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481390215 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8102316904 | ||||||||
| FaxNumber: | 8102316906 | ||||||||
| Practice Location | |||||||||
| Address1: | 10200 PROFESSIONAL CENTER DR. | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | HAMBURG | ||||||||
| State: | MI | ||||||||
| PostalCode: | 48139 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8102316904 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/25/2008 | ||||||||
| LastUpdateDate: | 08/25/2008 | ||||||||
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| AuthorizedOfficialLastName: | GOBLE | ||||||||
| AuthorizedOfficialFirstName: | RODNEY | ||||||||
| AuthorizedOfficialMiddleName: | P. | ||||||||
| AuthorizedOfficialTitleorPosition: | CO-OWNER | ||||||||
| AuthorizedOfficialTelephone: | 8102316904 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MPT | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | Y | 193400000X SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.