Healthcare Provider Details

I. General information

NPI: 1255595963
Provider Name (Legal Business Name): ADL REHABILITATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2008
Last Update Date: 07/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

565 GENERAL AVE SUITE A
SPRINGFIELD MI
49037-7553
US

IV. Provider business mailing address

565 GENERAL AVE SUITE A
SPRINGFIELD MI
49037-7553
US

V. Phone/Fax

Practice location:
  • Phone: 269-568-5683
  • Fax: 866-303-9355
Mailing address:
  • Phone: 269-568-5683
  • Fax: 866-303-9355

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5501007813
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number5201006389
License Number StateMI

VIII. Authorized Official

Name: MR. CHRISTIAN M PETROVICH
Title or Position: MANAGING MEMBER
Credential: MS OTR
Phone: 269-568-5683