Organization
MICHIANA THERAPY SERVICES INCORPORATED
Active
Organization
MICHIANA THERAPY SERVICES INCORPORATED
Active
Other names
Orthopedic and Sports Physical Therapy
Organization subpart
No
Provider details
NPI number
Authorized official
MR. GERALD HERNANDEZ ESPIRITU PT (PRESIDENT)
(269) 925-9491
Entity
Organization
Contact information
Practice address
1850 PIPESTONE RD, BENTON HARBOR, MI 49022-2334
(269) 925-9491
(269) 925-9553
Mailing address
1828 HASS DR, SOUTH BEND, IN 46635-2042
(574) 289-2030
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
MI2570
MEDICARE NUMBER (PTAN)
MI
Enumeration date
01/02/2010
Last updated
09/12/2010
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