Healthcare Provider Details

I. General information

NPI: 1487604203
Provider Name (Legal Business Name): IN HOME REHAB OF DICKINSON COUNTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 07/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

W3101 RIDGECREST DR
VULCAN MI
49892-8290
US

IV. Provider business mailing address

PO BOX 163
LORETTO MI
49852-0163
US

V. Phone/Fax

Practice location:
  • Phone: 906-563-8920
  • Fax: 906-563-8942
Mailing address:
  • Phone: 906-563-8920
  • Fax: 906-563-8942

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: MS. CHERYL L CARLSON
Title or Position: OWNER
Credential: P.T.
Phone: 906-563-8920