1407060221 NPI number — HEALTHTRAK PHYSICAL THERAPY INC

Table of content: (NPI 1407060221)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407060221 NPI number — HEALTHTRAK PHYSICAL THERAPY INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HEALTHTRAK PHYSICAL THERAPY 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:
1407060221
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/22/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
903 N EUCLID AVE
Provider Second Line Business Mailing Address:
SUITE 3
Provider Business Mailing Address City Name:
BAY CITY
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48706-2478
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
989-684-5009
Provider Business Mailing Address Fax Number:
989-684-6929

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
903 N EUCLID AVE
Provider Second Line Business Practice Location Address:
SUITE 3
Provider Business Practice Location Address City Name:
BAY CITY
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48706-2478
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
989-684-5009
Provider Business Practice Location Address Fax Number:
989-684-6929
Provider Enumeration Date:
05/10/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ECKHOUT
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
T
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
989-684-5009

Provider Taxonomy Codes

  • Taxonomy code: 174400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 30649 . This is a "BLUE CARE NETWORK PROV #" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 4784651 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4617396 . This is a "AETNA PROVIDER NUMBER" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 0981311 . This is a "HEALTHPLUS PROV #" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 30649 . This is a "BLUE CROSS OF MI PROV#" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1009815 . This is a "MCLAREN PROVIDER NUMBER" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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