Basic Information
| Provider Information | |||||||||
| NPI: | 1710261466 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MICHIGAN REHABILITATION SPECIALISTS OF DEXTER LLC | ||||||||
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| OtherOrganizationName: | MICHIGAN REHABILITATION SPECIALISTS | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 215 | ||||||||
| Address2: | |||||||||
| City: | HAMBURG | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481390215 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8102316904 | ||||||||
| FaxNumber: | 8102316906 | ||||||||
| Practice Location | |||||||||
| Address1: | 2820 BAKER RD | ||||||||
| Address2: | SUITE 201 | ||||||||
| City: | DEXTER | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481301181 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7344249710 | ||||||||
| FaxNumber: | 7344249711 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/29/2011 | ||||||||
| LastUpdateDate: | 08/27/2012 | ||||||||
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| AuthorizedOfficialLastName: | DAVIS | ||||||||
| AuthorizedOfficialFirstName: | MATTHEW | ||||||||
| AuthorizedOfficialMiddleName: | LINCOLN | ||||||||
| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 8102316904 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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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.