Provider Demographics
NPI:1902175805
Name:MARTIAL ARTS THERAPY
Entity Type:Organization
Organization Name:MARTIAL ARTS THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEAD INSTRUCTOR
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:J
Authorized Official - Last Name:REICHER
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:517-375-0252
Mailing Address - Street 1:PO BOX 995
Mailing Address - Street 2:
Mailing Address - City:FOWLERVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48836-0995
Mailing Address - Country:US
Mailing Address - Phone:517-375-0252
Mailing Address - Fax:
Practice Address - Street 1:7800 W SHARPE RD
Practice Address - Street 2:
Practice Address - City:FOWLERVILLE
Practice Address - State:MI
Practice Address - Zip Code:48836-8750
Practice Address - Country:US
Practice Address - Phone:517-375-0252
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-21
Last Update Date:2011-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283XC2000XHospitalsRehabilitation HospitalChildren
No273Y00000XHospital UnitsRehabilitation Unit