Provider Demographics
NPI:1861722548
Name:MICHIANA THERAPY SERVICES INCORPORATED
Entity type:Organization
Organization Name:MICHIANA THERAPY SERVICES INCORPORATED
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:HERNANDEZ
Authorized Official - Last Name:ESPIRITU
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:269-925-9491
Mailing Address - Street 1:1828 HASS DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46635-2042
Mailing Address - Country:US
Mailing Address - Phone:574-289-2030
Mailing Address - Fax:
Practice Address - Street 1:1850 PIPESTONE RD
Practice Address - Street 2:
Practice Address - City:BENTON HARBOR
Practice Address - State:MI
Practice Address - Zip Code:49022-2334
Practice Address - Country:US
Practice Address - Phone:269-925-9491
Practice Address - Fax:269-925-9553
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-02
Last Update Date:2010-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIMI2570OtherMEDICARE NUMBER (PTAN)