Organization
JACKSON PREFERRED REHAB LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KARTHYAYANI KUNCHAPPA PT (CEO)
(866) 568-3100
Entity
Organization
Contact information
Practice address
119 W MAIN ST, HOMER, MI 49245-1023
(866) 568-3100
(517) 568-3133
Mailing address
119 W MAIN ST, HOMER, MI 49245-1023
(866) 568-3100
(517) 568-3133
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
KK007396
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
650C807050
BLUE CROSS
MI
01
—
KK007396
LIC NUMBER
MI
Enumeration date
01/22/2008
Last updated
02/02/2009
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