Organization
CENTER FOR PHYSICAL REHABILITATION INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DAN K. DISTIN PT, ATC (PRESIDENT)
(616) 954-0959
Entity
Organization
Contact information
Practice address
5060 CASCADE RD SE, SUITE A, GRAND RAPIDS, MI 49546-3808
(616) 954-0950
(616) 954-1728
Mailing address
5060 CASCADE RD SE, SUITE A, GRAND RAPIDS, MI 49546-3808
(616) 954-0950
(616) 954-1728
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
30380
BC/BS
MI
Enumeration date
05/19/2006
Last updated
05/08/2009
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