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General NPI Number Information
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NPI Number | 1386937530
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Entity Type | Organization
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Legal Business Name | GREAT NORTHERN REHAB P C
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Dates
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Enumeration Date | 05/20/2011
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Last Update Date | 04/30/2012
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Provider Practice Location Address
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Address Line | 1310 E CLOVERLAND DR
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City | IRONWOOD
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State | MI
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Zip | 49938-1606
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Country | US
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Telephone | 906-932-4200
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Fax | 906-932-4201
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Provider Business Mailing Address
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Address Line | 2620 SE MARICAMP RD
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City | OCALA
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State | FL
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Zip | 34471-5582
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Country | US
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Telephone | 352-732-8868
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Fax | 352-732-8890
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Authorized Official
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Title or Position | CEO/PRESIDENT
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Name | MR. RICHARD W SHUTES
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Credential |
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Telephone | 352-732-8868
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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