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General NPI Number Information
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NPI Number | 1306280219
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Entity Type | Organization
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Legal Business Name | CUSTOM REHAB SOLUTIONS, INC.
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Dates
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Enumeration Date | 04/22/2013
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Last Update Date | 04/22/2013
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Provider Practice Location Address
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Address Line | 8250 LOCKERBIE RD
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City | PARMA
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State | MI
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Zip | 49269-9335
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Country | US
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Telephone | 517-740-8875
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Fax |
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Provider Business Mailing Address
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Address Line | 8250 LOCKERBIE RD
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City | PARMA
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State | MI
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Zip | 49269-9335
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Country | US
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Telephone | 517-740-8875
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. FRED M HETHERWICK
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Credential |
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Telephone | 517-945-4980
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 172M00000X
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Taxonomy Name | Mechanotherapist
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License Number | 1379518
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License Number State | MI
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