Healthcare Provider Details

I. General information

NPI: 1003025263
Provider Name (Legal Business Name): MOUNTAIN TOWN REHAB, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 06/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1106 W HIGH ST
MT PLEASANT MI
48858-2242
US

IV. Provider business mailing address

1106 W HIGH ST
MT PLEASANT MI
48858-2242
US

V. Phone/Fax

Practice location:
  • Phone: 989-779-2920
  • Fax: 989-772-9424
Mailing address:
  • Phone: 989-779-2920
  • Fax: 989-772-9424

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5501005383
License Number StateMI

VIII. Authorized Official

Name: DR. MARK THOMAS STANSBERRY
Title or Position: OWNER
Credential: PT
Phone: 989-779-2920