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General NPI Number Information
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NPI Number | 1952902652
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Entity Type | Organization
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Legal Business Name | MICHIGAN REHAB AND PERFORMANCE
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Dates
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Enumeration Date | 11/08/2020
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Last Update Date | 03/27/2025
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Provider Practice Location Address
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Address Line | 324 S JAMES ST
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City | LUDINGTON
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State | MI
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Zip | 49431-2106
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Country | US
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Telephone | 231-923-6349
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Fax | 734-456-6364
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Provider Business Mailing Address
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Address Line | 1098 ANN ARBOR RD W STE 666
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City | PLYMOUTH
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State | MI
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Zip | 48170-2129
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Country | US
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Telephone | 231-923-6349
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Fax | 734-456-6364
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Authorized Official
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Title or Position | OWNER OPERATOR
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Name | JACOB M BLACKMER
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Credential | PT, DPT
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Telephone | 231-923-6349
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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