Provider Demographics
NPI:1538211925
Name:ELK RAPIDS PHYSICAL THERAPY, PC
Entity type:Organization
Organization Name:ELK RAPIDS PHYSICAL THERAPY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:RHONDA
Authorized Official - Middle Name:BAKER
Authorized Official - Last Name:LAMMERS
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:231-264-6682
Mailing Address - Street 1:128 AMES ST
Mailing Address - Street 2:
Mailing Address - City:ELK RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49629-9739
Mailing Address - Country:US
Mailing Address - Phone:231-264-6682
Mailing Address - Fax:
Practice Address - Street 1:128 AMES ST
Practice Address - Street 2:
Practice Address - City:ELK RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49629-9739
Practice Address - Country:US
Practice Address - Phone:231-264-6682
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-17
Last Update Date:2015-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501003682225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI22361OtherPRIORITY HEALTH
MI0Z557010OtherBLUE CROSS BLUE SHIELD
MI7823578OtherAETNA
MI7823578OtherAETNA