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General NPI Number Information
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NPI Number | 1528248036
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Entity Type | Organization
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Legal Business Name | RIVERVIEW PHYSICAL THERAPY AND REHAB,LLC
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Dates
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Enumeration Date | 11/13/2007
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Last Update Date | 04/29/2008
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Provider Practice Location Address
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Address Line | 1702 WATER ST
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City | PORT HURON
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State | MI
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Zip | 48060-4136
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Country | US
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Telephone | 810-966-9102
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Fax | 810-966-9104
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Provider Business Mailing Address
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Address Line | 1702 WATER ST
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City | PORT HURON
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State | MI
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Zip | 48060-4136
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Country | US
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Telephone | 810-966-9102
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Fax | 810-966-9104
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Authorized Official
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Title or Position | PHYSICAL THERAPIST
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Name | MR. HARGOPAL TEKUMULLA
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Credential | PT
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Telephone | 810-966-9102
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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 | 5201003768
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License Number State | MI
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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 | 5501008202
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License Number State | MI
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