1295123586 NPI number — SAGINAW HORIZON PHYSICAL THERAPY AND REHABILITATION, PLLC

Table of content: (NPI 1295123586)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295123586 NPI number — SAGINAW HORIZON PHYSICAL THERAPY AND REHABILITATION, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SAGINAW HORIZON PHYSICAL THERAPY AND REHABILITATION, PLLC
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:
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:
1295123586
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/29/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4705 TOWNE CENTRE RD
Provider Second Line Business Mailing Address:
SUITE 101
Provider Business Mailing Address City Name:
SAGINAW
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48604-2818
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
989-401-5890
Provider Business Mailing Address Fax Number:
989-401-5892

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4705 TOWNE CENTRE RD
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
SAGINAW
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48604-2818
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
989-401-5890
Provider Business Practice Location Address Fax Number:
989-401-5892
Provider Enumeration Date:
01/08/2015

Additional Information

Authorized Official

Authorized Official Last Name:
CHALASANI
Authorized Official First Name:
KRISHNA
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT/ADMINISTRATOR
Authorized Official Telephone Number:
989-401-5890

Provider Taxonomy Codes

  • Taxonomy code: 261QP2000X , with the licence number:  E2848Q , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QR0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1064831 . This is a "HEALTH PLUS OF MICHIGAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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