Healthcare Provider Details

I. General information

NPI: 1578572608
Provider Name (Legal Business Name): MISSION PHYSICAL THERAPY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2006
Last Update Date: 10/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 S MISSION ST SUITE A
MT PLEASANT MI
48858-2846
US

IV. Provider business mailing address

555 S MISSION ST SUITE A
MT PLEASANT MI
48858-2846
US

V. Phone/Fax

Practice location:
  • Phone: 989-772-5800
  • Fax: 989-772-4342
Mailing address:
  • Phone: 989-772-5800
  • Fax: 989-772-4342

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number StateMI

VIII. Authorized Official

Name: CHRISTOPHER AHMED SAKALA
Title or Position: OWNER-R.P.T.
Credential:
Phone: 989-772-5800