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Organization
MARY FREE BED REHABILITATION, L.L.C
Active
Organization
MARY FREE BED REHABILITATION, L.L.C
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RANDALL DENEFF (PRESIDENT)
(616) 840-8317
Entity
Organization
Contact information
Practice address
1845 LIVERNOIS RD, TROY, MI 48083-1731
(248) 362-2150
(248) 362-1702
Mailing address
1845 LIVERNOIS RD, TROY, MI 48083-1731
(248) 362-2150
(248) 362-1702
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
01686
MI
2251G0304X
Geriatric Physical Therapist
01686
MI
2251H1200X
Hand Physical Therapist
01686
MI
2251N0400X
Neurology Physical Therapist
01686
MI
2251P0200X
Pediatric Physical Therapist
01686
MI
2251S0007X
Sports Physical Therapist
01686
MI
2251X0800X
Orthopedic Physical Therapist
01686
MI
225X00000X
Occupational Therapist
5201002959
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
134812400
US DEPT OF LABOR
MI
01
—
16854
MCARE
MI
01
—
30688
BCBSM
MI
01
—
382473857
PPOM
MI
01
—
4669868
AETNA
MI
01
—
89046A
HAP
MI
01
—
P459578
BLUE CHOICE
MI
Enumeration date
11/17/2005
Last updated
08/03/2020
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