Healthcare Provider Details

I. General information

NPI: 1205682879
Provider Name (Legal Business Name): UNIVERSITY REHABILITATION ALLIANCE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2024
Last Update Date: 07/16/2024
Certification Date: 07/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3181 SANDHILL RD
MASON MI
48854-9425
US

IV. Provider business mailing address

3181 SANDHILL RD
MASON MI
48854-9425
US

V. Phone/Fax

Practice location:
  • Phone: 517-336-6060
  • Fax: 517-336-6050
Mailing address:
  • Phone: 517-336-6060
  • Fax: 517-336-6050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P0301X
TaxonomyBrain Injury Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084P0301X
TaxonomyBrain Injury Medicine (Psychiatry & Neurology) Physician
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER MUCKEY
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 517-336-6060