Provider Demographics
NPI:1902154388
Name:KALAMAZOO FUNCTIONAL REHABILIATION- THERAPY TEAM LLC
Entity Type:Organization
Organization Name:KALAMAZOO FUNCTIONAL REHABILIATION- THERAPY TEAM LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BOL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:269-870-6459
Mailing Address - Street 1:3237 OLD COLONY RD
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49008-4915
Mailing Address - Country:US
Mailing Address - Phone:269-870-6459
Mailing Address - Fax:269-978-8916
Practice Address - Street 1:6376 QUAIL RUN DR
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49009-2811
Practice Address - Country:US
Practice Address - Phone:269-544-3764
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-16
Last Update Date:2012-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty