Provider Demographics
NPI:1255352407
Name:CENTRIC PHYSICAL AND OCCUPATIONAL THERAPY SERVICES,INC
Entity type:Organization
Organization Name:CENTRIC PHYSICAL AND OCCUPATIONAL THERAPY SERVICES,INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:BANKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:810-569-5368
Mailing Address - Street 1:PO BOX 405
Mailing Address - Street 2:
Mailing Address - City:LINDEN
Mailing Address - State:MI
Mailing Address - Zip Code:48451-0405
Mailing Address - Country:US
Mailing Address - Phone:810-569-5368
Mailing Address - Fax:810-715-1211
Practice Address - Street 1:6136 PINE CREEK CT
Practice Address - Street 2:
Practice Address - City:GRAND BLANC
Practice Address - State:MI
Practice Address - Zip Code:48439-9768
Practice Address - Country:US
Practice Address - Phone:810-487-1337
Practice Address - Fax:810-715-1211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2019-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201000803225X00000X
MI5501010057225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0P29760Medicare PIN
MIP29760003Medicare ID - Type UnspecifiedPHYSCIAL THERAPY