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Organization
UP REHAB SERVICES LLC
Active
Organization
UP REHAB SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RUSSELL TODD TRIPP (COO)
(906) 225-5570
Entity
Organization
Contact information
Practice address
505 N HOOPER ST, KINGSFORD, MI 49802-5406
(906) 776-9003
(906) 776-9063
Mailing address
555 COUNTY ROAD HQ, MARQUETTE, MI 49855-8855
(906) 225-5570
(906) 225-5572
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
—
—
225100000X
Physical Therapist
Primary
—
—
225200000X
Physical Therapy Assistant
—
—
225X00000X
Occupational Therapist
—
—
235Z00000X
Speech-Language Pathologist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0B20128
BCBS OF MICHIGAN
MI
05
—
100075308
—
WI
01
—
614387700
DEPT OF LABOR WC
—
05
—
CV0004527
—
MI
Enumeration date
01/12/2007
Last updated
09/20/2019
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