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General NPI Number Information
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NPI Number | 1366588196
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Entity Type | Organization
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Legal Business Name | DERY REHABILITATION SERVICES, PC
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Dates
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Enumeration Date | 01/29/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 901 W MAIN ST
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City | LOWELL
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State | MI
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Zip | 49331-1503
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Country | US
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Telephone | 616-897-7055
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Fax | 616-897-7366
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Provider Business Mailing Address
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Address Line | PO BOX 268
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City | LOWELL
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State | MI
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Zip | 49331-0268
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Country | US
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Telephone | 616-897-7055
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Fax | 616-897-7366
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Authorized Official
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Title or Position | VICE-PRESIDENT
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Name | CASIMIR A KILYANEK
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Credential | PT
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Telephone | 616-897-7055
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State | MI
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