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General NPI Number Information
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NPI Number | 1780775809
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Entity Type | Organization
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Legal Business Name | CENTRAL MICHIGAN REHABILITATION, LLC
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Dates
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Enumeration Date | 09/27/2006
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Last Update Date | 03/19/2010
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Provider Practice Location Address
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Address Line | 1500 W. HIGH STREET
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City | MT. PLEASANT
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State | MI
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Zip | 48858
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Country | US
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Telephone | 989-772-0258
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Fax | 989-953-4603
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Provider Business Mailing Address
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Address Line | 1500 W. HIGH STREET
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City | MT. PLEASANT
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State | MI
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Zip | 48858
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Country | US
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Telephone | 989-772-0258
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Fax | 989-953-4603
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Authorized Official
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Title or Position | CLINIC DIRECTOR/PT
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Name | MR. MANISH BONDALE
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Credential | PT
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Telephone | 989-772-0258
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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 | 5501009360
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License Number State | MI
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