Provider Demographics
NPI:1174719504
Name:MICHIGAN REHABILITATION SPECIALISTS OF DAVISON PC
Entity type:Organization
Organization Name:MICHIGAN REHABILITATION SPECIALISTS OF DAVISON PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RODNEY
Authorized Official - Middle Name:P
Authorized Official - Last Name:GOBLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:810-231-6904
Mailing Address - Street 1:10078 LAPEER RD
Mailing Address - Street 2:
Mailing Address - City:DAVISON
Mailing Address - State:MI
Mailing Address - Zip Code:48423-9031
Mailing Address - Country:US
Mailing Address - Phone:810-231-6904
Mailing Address - Fax:
Practice Address - Street 1:10078 LAPEER RD
Practice Address - Street 2:
Practice Address - City:DAVISON
Practice Address - State:MI
Practice Address - Zip Code:48423-9031
Practice Address - Country:US
Practice Address - Phone:810-231-6904
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-19
Last Update Date:2007-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy