Healthcare Provider Details

I. General information

NPI: 1902288863
Provider Name (Legal Business Name): CENTER FOR PHYSICAL REHABILITATION AND THERAPY LP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2015
Last Update Date: 01/27/2020
Certification Date: 01/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5060 CASCADE RD SE SUITE A
GRAND RAPIDS MI
49546-3808
US

IV. Provider business mailing address

5060 CASCADE RD SE SUITE A
GRAND RAPIDS MI
49546-3808
US

V. Phone/Fax

Practice location:
  • Phone: 616-954-0950
  • Fax:
Mailing address:
  • Phone:
  • 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: RICHARD BINSTEIN
Title or Position: VP, AUTHORIZED OFFICIAL
Credential:
Phone: 713-297-7000