Organization
GREAT NORTHERN REHAB P C
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RICHARD W SHUTES (CEO/PRESIDENT)
(352) 732-8868
Entity
Organization
Contact information
Practice address
1310 E CLOVERLAND DR, IRONWOOD, MI 49938-1606
(906) 932-4200
(906) 932-4201
Mailing address
2620 SE MARICAMP RD, OCALA, FL 34471-5582
(352) 732-8868
(352) 732-8890
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
225X00000X
Occupational Therapist
—
—
Other
Enumeration date
05/20/2011
Last updated
04/30/2012
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