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General NPI Number Information
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NPI Number | 1336043884
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Entity Type | Organization
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Legal Business Name | TRAVERSE NEURO REHABILITATION
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Dates
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Enumeration Date | 10/07/2026
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Last Update Date | 10/07/2026
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Provider Practice Location Address
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Address Line | 654 HASTINGS ST
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City | TRAVERSE CITY
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State | MI
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Zip | 49686-3438
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Country | US
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Telephone | 231-252-2485
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 5256
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City | TRAVERSE CITY
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State | MI
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Zip | 49696-5256
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Country | US
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Telephone | 231-883-1350
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | MARK WILSON
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Credential | BSW
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Telephone | 231-883-1350
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 374U00000X
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Taxonomy Name | Home Health Aide
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License Number |
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License Number State | NULL
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