Basic Information
| Provider Information | |||||||||
| NPI: | 1720465339 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MICHIGAN THERAPY CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2111 MERRITT RD STE 101 | ||||||||
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| City: | EAST LANSING | ||||||||
| State: | MI | ||||||||
| PostalCode: | 488236916 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5173324263 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2111 MERRITT RD | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | EAST LANSING | ||||||||
| State: | MI | ||||||||
| PostalCode: | 488236916 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5173324263 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/04/2015 | ||||||||
| LastUpdateDate: | 05/04/2015 | ||||||||
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| AuthorizedOfficialLastName: | BRESFORD | ||||||||
| AuthorizedOfficialFirstName: | BOB | ||||||||
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| AuthorizedOfficialTitleorPosition: | MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 5173324263 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QX0100X | 5201009030 | MI | Y | Ambulatory Health Care Facilities | Clinic/Center | Occupational Medicine |
No ID Information.