Organization
GREAT LAKES PHYSICAL THERAPY AND REHABILITATION LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DAVID JAMES STAPELS (PRESIDENT)
(586) 321-4563
Entity
Organization
Contact information
Practice address
12434 E 12 MILE RD STE 101, WARREN, MI 48093-3536
(586) 578-9121
(586) 578-9124
Mailing address
12434 E 12 MILE RD STE 101, WARREN, MI 48093-3536
(586) 578-9121
(586) 578-9124
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
E6533E
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12434
ADDRESS
—
Enumeration date
07/01/2015
Last updated
07/01/2015
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