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General NPI Number Information
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NPI Number | 1306928841
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Entity Type | Organization
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Legal Business Name | NORTHSHORE REHAB PLLC
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Dates
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Enumeration Date | 10/20/2006
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Last Update Date | 02/18/2010
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Provider Practice Location Address
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Address Line | 901 W FRONT ST SUITE B
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City | TRAVERSE CITY
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State | MI
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Zip | 49684-2374
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Country | US
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Telephone | 231-947-5071
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Fax | 231-947-5094
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Provider Business Mailing Address
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Address Line | 901 W FRONT ST SUITE B
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City | TRAVERSE CITY
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State | MI
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Zip | 49684-2374
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Country | US
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Telephone | 231-947-5071
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Fax | 231-947-5094
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Authorized Official
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Title or Position | PRESIDENT S CORPORATION
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Name | KAREN LYNN MEYER
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Credential | DO
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Telephone | 231-947-5071
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2081P2900X
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Taxonomy Name | Pain Medicine (Physical Medicine & Rehabilitation) Physician
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License Number | 5101013561
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License Number State | MI
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