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General NPI Number Information
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NPI Number | 1720465339
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Entity Type | Organization
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Legal Business Name | MICHIGAN THERAPY CENTER
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Dates
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Enumeration Date | 05/04/2015
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Last Update Date | 05/04/2015
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Provider Practice Location Address
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Address Line | 2111 MERRITT RD SUITE 101
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City | EAST LANSING
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State | MI
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Zip | 48823-6916
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Country | US
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Telephone | 517-332-4263
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Fax |
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Provider Business Mailing Address
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Address Line | 2111 MERRITT RD STE 101
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City | EAST LANSING
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State | MI
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Zip | 48823-6916
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Country | US
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Telephone | 517-332-4263
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | BOB BRESFORD
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Credential |
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Telephone | 517-332-4263
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QX0100X
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Taxonomy Name | Occupational Medicine Clinic/Center
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License Number | 5201009030
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License Number State | MI
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