MEDICARE: MID MICHIGAN PHYSICAL THERAPY SPECIALISTS, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1134240658
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MID MICHIGAN PHYSICAL THERAPY SPECIALISTS, LLC

Provider Business Mailing Address
First Line	:	PO BOX 323
Second Line	:
City	:	FOWLERVILLE
State	:	MI
Zip	:	48836-0323
Country	:	US
Telephone Number	:	517-223-8308
Fax Number	:	517-223-8344

Provider Business Practice Location Address
First Line	:	125 E GRAND RIVER AVE
Second Line	:
City	:	FOWLERVILLE
State	:	MI
Zip	:	48836-5137
Country	:	US
Telephone Number	:	517-223-8308
Fax Number	:	517-223-8344

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MS. GLENDA K MAINES
Credential	:	PT, M ED, OCS
Telephone Number	:	517-223-8308

Provider Enumeration Date	:	04/02/2007
Last Update Date	:	07/27/2015

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