Healthcare Provider Details

I. General information

NPI: 1700212479
Provider Name (Legal Business Name): FAMILY FITNESS AND REHABILITATION, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2013
Last Update Date: 09/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

122 S MORENCI AVE STE A
MIO MI
48647-2508
US

IV. Provider business mailing address

122 S MORENCI AVE STE A P.O. BOX 1032
MIO MI
48647-2508
US

V. Phone/Fax

Practice location:
  • Phone: 989-826-6830
  • Fax: 989-826-6860
Mailing address:
  • Phone: 989-826-6830
  • Fax: 989-826-6860

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: BECKY L SULLIVAN
Title or Position: RESIDENT AGENT
Credential:
Phone: 989-826-6830