Healthcare Provider Details

I. General information

NPI: 1861722548
Provider Name (Legal Business Name): MICHIANA THERAPY SERVICES INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/02/2010
Last Update Date: 09/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1850 PIPESTONE RD
BENTON HARBOR MI
49022-2334
US

IV. Provider business mailing address

1828 HASS DR
SOUTH BEND IN
46635-2042
US

V. Phone/Fax

Practice location:
  • Phone: 269-925-9491
  • Fax: 269-925-9553
Mailing address:
  • Phone: 574-289-2030
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. GERALD HERNANDEZ ESPIRITU
Title or Position: PRESIDENT
Credential: PT
Phone: 269-925-9491