1255352407 NPI number — CENTRIC PHYSICAL AND OCCUPATIONAL THERAPY SERVICES,INC

Table of content: (NPI 1255352407)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255352407 NPI number — CENTRIC PHYSICAL AND OCCUPATIONAL THERAPY SERVICES,INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENTRIC PHYSICAL AND OCCUPATIONAL THERAPY SERVICES,INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1255352407
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/10/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 405
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LINDEN
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48451-0405
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
810-569-5368
Provider Business Mailing Address Fax Number:
810-715-1211

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6136 PINE CREEK CT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GRAND BLANC
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48439-9768
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
810-487-1337
Provider Business Practice Location Address Fax Number:
810-715-1211
Provider Enumeration Date:
07/22/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BANKS
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
ROBERT
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
810-569-5368

Provider Taxonomy Codes

  • Taxonomy code: 225X00000X , with the licence number:  5201000803 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225100000X , with the licence number: 5501010057 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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