Organization
INDEPENDENCE REHAB LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. KIRK CHRISTOPHER RANDALL P.T. (OWNER)
(616) 340-6407
Entity
Organization
Contact information
Practice address
3753 BASSWOOD DR SW, GRANDVILLE, MI 49418-2003
(616) 340-6407
(616) 301-2882
Mailing address
3753 BASSWOOD DR SW, GRANDVILLE, MI 49418-2003
(616) 340-6407
(616) 301-2882
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
5501005678
MI
Other
Enumeration date
02/25/2007
Last updated
02/12/2008
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