Healthcare Provider Details

I. General information

NPI: 1841493228
Provider Name (Legal Business Name): MTA PHYSICAL MEDICINE AND REHABILITATION, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2007
Last Update Date: 03/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2727 S PENNSYLVANIA AVE
LANSING MI
48910-3488
US

IV. Provider business mailing address

1701 LAKE LANSING RD SUITE 100
LANSING MI
48912-3798
US

V. Phone/Fax

Practice location:
  • Phone: 517-377-8252
  • Fax:
Mailing address:
  • Phone: 517-485-0001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL T ANDARY
Title or Position: OWNER
Credential: MD
Phone: 517-377-8252