Healthcare Provider Details

I. General information

NPI: 1548489925
Provider Name (Legal Business Name): CASCADES ORTHOPEDIC REHABILITATION SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2007
Last Update Date: 09/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3235 E MICHIGAN AVE
JACKSON MI
49202-3971
US

IV. Provider business mailing address

3235 E MICHIGAN AVE
JACKSON MI
49202-3971
US

V. Phone/Fax

Practice location:
  • Phone: 517-990-1242
  • Fax: 517-787-9680
Mailing address:
  • Phone: 517-990-1242
  • Fax: 517-787-9680

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5501007541
License Number StateMI

VIII. Authorized Official

Name: BALASUBRAMANIYAM PISUPATI
Title or Position: OWNER
Credential: PT
Phone: 517-990-1242