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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