Healthcare Provider Details

I. General information

NPI: 1255352407
Provider Name (Legal Business Name): CENTRIC PHYSICAL AND OCCUPATIONAL THERAPY SERVICES,INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2006
Last Update Date: 06/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6136 PINE CREEK CT
GRAND BLANC MI
48439-9768
US

IV. Provider business mailing address

PO BOX 405
LINDEN MI
48451-0405
US

V. Phone/Fax

Practice location:
  • Phone: 810-487-1337
  • Fax: 810-715-1211
Mailing address:
  • Phone: 810-569-5368
  • Fax: 810-715-1211

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5501010057
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number5201000803
License Number StateMI

VIII. Authorized Official

Name: MR. MICHAEL ROBERT BANKS
Title or Position: OWNER
Credential:
Phone: 810-569-5368