Healthcare Provider Details

I. General information

NPI: 1376771287
Provider Name (Legal Business Name): MARQUETTE REHABILITATION & SPORTS MEDICINE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2009
Last Update Date: 01/18/2022
Certification Date: 01/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1455 W FAIR AVE
MARQUETTE MI
49855-2654
US

IV. Provider business mailing address

1455 W FAIR AVE
MARQUETTE MI
49855-2654
US

V. Phone/Fax

Practice location:
  • Phone: 906-226-0574
  • Fax: 888-347-1135
Mailing address:
  • Phone: 906-226-0574
  • Fax: 888-347-1135

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number5501013363
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: DR. KIPLIN M HARTMAN
Title or Position: OWNER/PHYSICAL THERAPIST
Credential: DPT
Phone: 906-362-0013