MEDICARE: THERAPY SPECIALISTS, INC.

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	225100000X	Physical Therapist	5501004057	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	650D157400	OTHER	MI	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1679598452
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THERAPY SPECIALISTS, INC.

Provider Business Mailing Address
First Line	:	1444 MICHIGAN ST NE
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49503-2028
Country	:	US
Telephone Number	:	616-292-6736
Fax Number	:	616-774-0961

Provider Business Practice Location Address
First Line	:	1444 MICHIGAN ST NE
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49503-2028
Country	:	US
Telephone Number	:	616-292-6736
Fax Number	:	616-774-0961

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. STEVEN LEO STRATTON
Credential	:	MHSPT
Telephone Number	:	616-292-6736

Provider Enumeration Date	:	07/13/2006
Last Update Date	:	09/04/2013

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