MEDICARE: IN HOME THERAPY OF GRAND RAPIDS, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist
2	261QP2000X	Physical Therapy Clinic/Center	5501010413	MI
3	261QR0400X	Rehabilitation Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1295098945
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IN HOME THERAPY OF GRAND RAPIDS, LLC

Provider Business Mailing Address
First Line	:	2433 VALENTINE BLVD NE
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49525-3070
Country	:	US
Telephone Number	:	616-799-7891
Fax Number	:	616-863-2030

Provider Business Practice Location Address
First Line	:	2433 VALENTINE BLVD NE
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49525-3070
Country	:	US
Telephone Number	:	616-799-7891
Fax Number	:	616-863-2030

Authorized Official
Title or Position	:	MANAGER
Name	:	MR. TIMOTHY M BATT
Credential	:	PT
Telephone Number	:	616-799-7891

Provider Enumeration Date	:	06/18/2012
Last Update Date	:	10/05/2021

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