Healthcare Provider Details

I. General information

NPI: 1912764127
Provider Name (Legal Business Name): BMOR LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2024
Last Update Date: 03/04/2024
Certification Date: 03/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

322 N LINCOLN RD
ESCANABA MI
49829-1305
US

IV. Provider business mailing address

3 HARBOR POINT LN
GLADSTONE MI
49837-2771
US

V. Phone/Fax

Practice location:
  • Phone: 906-553-7094
  • Fax: 906-212-2046
Mailing address:
  • Phone: 906-280-2995
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: JAYNE MARIE SZUKALOWSKI
Title or Position: OWNER
Credential:
Phone: 906-280-2995