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General NPI Number Information
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NPI Number | 1134240658
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Entity Type | Organization
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Legal Business Name | MID MICHIGAN PHYSICAL THERAPY SPECIALISTS, LLC
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Dates
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Enumeration Date | 04/02/2007
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Last Update Date | 07/27/2015
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Provider Practice Location Address
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Address Line | 125 E GRAND RIVER AVE
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City | FOWLERVILLE
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State | MI
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Zip | 48836-5137
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Country | US
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Telephone | 517-223-8308
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Fax | 517-223-8344
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Provider Business Mailing Address
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Address Line | PO BOX 323
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City | FOWLERVILLE
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State | MI
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Zip | 48836-0323
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Country | US
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Telephone | 517-223-8308
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Fax | 517-223-8344
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MS. GLENDA K MAINES
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Credential | PT, M ED, OCS
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Telephone | 517-223-8308
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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