Healthcare Provider Details

I. General information

NPI: 1760445399
Provider Name (Legal Business Name): RAINER B. LIEBERT PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2006
Last Update Date: 12/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1903 W MICHIGAN AVE
KALAMAZOO MI
49008-5200
US

IV. Provider business mailing address

1903 W MICHIGAN AVE
KALAMAZOO MI
49008-5200
US

V. Phone/Fax

Practice location:
  • Phone: 269-387-3248
  • Fax: 269-387-2744
Mailing address:
  • Phone: 269-387-3248
  • Fax: 269-387-2744

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5501009158
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: