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General NPI Number Information
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NPI Number | 1851764666
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Entity Type | Organization
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Legal Business Name | MIDLAND PHYSICAL THERAPY SPORTS REHAB
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Dates
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Enumeration Date | 11/03/2015
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Last Update Date | 11/03/2015
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Provider Practice Location Address
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Address Line | 4710 EASTMAN AVE
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City | MIDLAND
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State | MI
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Zip | 48640-2606
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Country | US
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Telephone | 989-341-1070
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Fax | 989-341-1072
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Provider Business Mailing Address
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Address Line | 4710 EASTMAN AVE
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City | MIDLAND
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State | MI
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Zip | 48640-2606
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Country | US
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Telephone | 989-341-1070
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Fax | 989-341-1072
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Authorized Official
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Title or Position | OWNER
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Name | JEFFERY BERARD
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Credential | DC
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Telephone | 989-341-1070
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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 |
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License Number State |
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