Healthcare Provider Details

I. General information

NPI: 1144047523
Provider Name (Legal Business Name): MICHIGAN OCCUPATIONAL HEALTH REHAB, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2024
Last Update Date: 09/25/2024
Certification Date: 09/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

840 E MOUNT HOPE AVE
LANSING MI
48910-3292
US

IV. Provider business mailing address

840 E MOUNT HOPE AVE
LANSING MI
48910-3292
US

V. Phone/Fax

Practice location:
  • Phone: 517-889-1177
  • Fax: 517-744-5630
Mailing address:
  • Phone: 517-889-1177
  • Fax: 517-744-5630

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: RANJITH SAMSON
Title or Position: ADMINISTRATOR
Credential: PT
Phone: 517-889-1177