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General NPI Number Information
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NPI Number | 1548489925
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Entity Type | Organization
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Legal Business Name | CASCADES ORTHOPEDIC REHABILITATION SERVICES
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Dates
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Enumeration Date | 04/24/2007
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Last Update Date | 09/20/2011
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Provider Practice Location Address
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Address Line | 3235 E MICHIGAN AVE
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City | JACKSON
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State | MI
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Zip | 49202-3971
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Country | US
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Telephone | 517-990-1242
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Fax | 517-787-9680
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Provider Business Mailing Address
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Address Line | 3235 E MICHIGAN AVE
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City | JACKSON
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State | MI
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Zip | 49202-3971
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Country | US
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Telephone | 517-990-1242
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Fax | 517-787-9680
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Authorized Official
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Title or Position | OWNER
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Name | BALASUBRAMANIYAM PISUPATI
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Credential | PT
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Telephone | 517-990-1242
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 5501007541
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License Number State | MI
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