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General NPI Number Information
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NPI Number | 1508848318
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Entity Type | Organization
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Legal Business Name | MARY FREE BED REHABILITATION, L.L.C
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Dates
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Enumeration Date | 11/17/2005
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Last Update Date | 08/03/2020
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Provider Practice Location Address
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Address Line | 1845 LIVERNOIS RD
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City | TROY
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State | MI
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Zip | 48083-1731
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Country | US
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Telephone | 248-362-2150
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Fax | 248-362-1702
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Provider Business Mailing Address
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Address Line | 1845 LIVERNOIS RD
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City | TROY
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State | MI
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Zip | 48083-1731
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Country | US
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Telephone | 248-362-2150
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Fax | 248-362-1702
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Authorized Official
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Title or Position | PRESIDENT
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Name | RANDALL DENEFF
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Credential |
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Telephone | 616-840-8317
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251G0304X
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Taxonomy Name | Geriatric Physical Therapist
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License Number | 01686
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 2251H1200X
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Taxonomy Name | Hand Physical Therapist
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License Number | 01686
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 2251N0400X
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Taxonomy Name | Neurology Physical Therapist
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License Number | 01686
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License Number State | MI
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Taxonomy #4
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Taxonomy Code | 2251P0200X
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Taxonomy Name | Pediatric Physical Therapist
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License Number | 01686
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License Number State | MI
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Taxonomy #5
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Taxonomy Code | 2251S0007X
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Taxonomy Name | Sports Physical Therapist
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License Number | 01686
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License Number State | MI
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Taxonomy #6
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Taxonomy Code | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number | 01686
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License Number State | MI
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Taxonomy #7
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 5201002959
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License Number State | MI
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Taxonomy #8
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 01686
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License Number State | MI
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