Healthcare Provider's Profile
| Full Name | |
|---|
| Type | Facility |
|---|
| Speciality | Physical Therapist |
|---|
| Location | 4489 M 61 Ste 6, Standish, Michigan |
|---|
| Accepts Medicare Assignments | Does not participate in Medicare Program. The facility may not accept medicare assignment. |
|---|
NPI Data:
- NPI Number: 1447553243
- Provider Enumeration Date: 12/16/2010
- Last Update Date: 06/13/2022
Medical Identifiers
Medical identifiers for
such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1447553243 | NPI | - | NPPES |
| 0987906 | Other | MI | HEALTH PLUS |
| 30738 | Other | MI | BLUE CARE NETWORK |
| 30738 | Other | MI | BLUE CROSS BLUE SHIELD OF MICHIGAN |
| 404679870 | Medicaid | MI | |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 225100000X | Physical Therapist | 5501005570 (Michigan) | Primary |
| 225100000X | Physical Therapist | 5501006073 (Michigan) | Secondary |
| 225100000X | Physical Therapist | 5501013753 (Michigan) | Secondary |
| 225100000X | Physical Therapist | (* (Not Available)) | Secondary |
| 225X00000X | Occupational Therapist | 1022345 (Michigan) | Secondary |
| 225XH1200X | Occupational Therapist - Hand | 1051100450 (Michigan) | Secondary |
| 225XP0200X | Occupational Therapist - Pediatrics | 5201007687 (Michigan) | Secondary |
| 235Z00000X | Speech-language Pathologist | 01092746 (Michigan) | Secondary |
Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. is NOT enrolled with medicare and thus cannot prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
|---|
4489 M 61 Ste 6,
Standish, MI 48658-9272
Ph: (989) 718-3171 |
4489 M 61 Ste 6,
Standish, MI 48658-9104
Ph: (989) 718-3171 |
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