Healthcare Provider Details

I. General information

NPI: 1194263731
Provider Name (Legal Business Name): SENIOR REHAB AND FITNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2017
Last Update Date: 05/01/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1820 MARYS WAY
KINGSFORD MI
49802-4248
US

IV. Provider business mailing address

1820 MARYS WAY
KINGSFORD MI
49802-4248
US

V. Phone/Fax

Practice location:
  • Phone: 906-282-1653
  • Fax: 906-563-8942
Mailing address:
  • Phone: 906-282-1653
  • Fax: 906-563-8942

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: CHERYL L CARLSON
Title or Position: OWNER
Credential: PT
Phone: 906-282-1653