Organization
ACTIVE PHYSICAL THERAPY AND REHAB SERVICES INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. CHAMUNDEESWARI MUTHUVINAYAGAM PHYSICALTHERAPIST (OWNER/ADMINISTRATOR)
(810) 966-8500
Entity
Organization
Contact information
Practice address
718 HURON AVE, PORT HURON, MI 48060-3704
(810) 966-8500
(810) 966-8600
Mailing address
718 HURON AVE, PORT HURON, MI 48060-3704
(810) 966-8500
(810) 966-8600
Taxonomy
Speciality
Code
Description
License number
State
261QR0400X
Rehabilitation Clinic/Center
Primary
N/A
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1053364679
BLUECARE NETWORK
MI
01
—
30045
BCBS
MI
01
—
30901
BCBS
MI
05
—
5183763
—
MI
Enumeration date
05/17/2006
Last updated
03/14/2016
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