=====================================================
General NPI Number Information
=====================================================
NPI Number | 1134392202
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FIRST REHAB PHYSICAL THERAPY P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/09/2008
-----------------------------------------------------
Last Update Date | 01/15/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4525 N M 37 HWY SUITE B
-----------------------------------------------------
City | MIDDLEVILLE
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49333-8166
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 269-795-4230
-----------------------------------------------------
Fax | 269-795-4191
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4525 N M 37 HWY SUITE B
-----------------------------------------------------
City | MIDDLEVILLE
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49333-8166
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 269-795-4230
-----------------------------------------------------
Fax | 269-795-4191
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICER
-----------------------------------------------------
Name | BRYAN HEMINGWAY
-----------------------------------------------------
Credential | MPT
-----------------------------------------------------
Telephone | 269-795-4230
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 5501010312
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------