Healthcare Provider Details

I. General information

NPI: 1407774235
Provider Name (Legal Business Name): REBEL PT & WELLNESS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2026
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

427 SEMINOLE RD STE 101C
NORTON SHORES MI
49444-3747
US

IV. Provider business mailing address

2229 SURFWOOD DR
MUSKEGON MI
49441-1161
US

V. Phone/Fax

Practice location:
  • Phone: 231-288-0566
  • Fax:
Mailing address:
  • Phone: 231-288-0566
  • Fax: 231-224-8767

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER GRELEWICZ
Title or Position: OWNER, PHYSICAL THERAPIST
Credential: PT
Phone: 231-288-0566