Active NPI
Michigan Rehabilitation Specialists of Fowlerville, LLC
- Durable Medical Equipment & Medical Supplies
- Lake Orion, MI
National Provider Identifier
1356966683
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Durable Medical Equipment & Medical Supplies
- Legal business name
- MICHIGAN REHABILITATION SPECIALISTS OF FOWLERVILLE, LLC
- Practice address
- 425 N Park Blvd Ste 100
Lake Orion, MI 48362-3189 - Phone
- (248) 693-6835
- NPI assigned
- Jun 12, 2020
- Last updated
- Jan 24, 2025
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Wade A Meyer
- Title
- VP Chief Compliance Officer
- Phone
- (630) 296-2222
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | NU | Primary |
Addresses
Primary practice location
425 N Park Blvd Ste 100
Lake Orion, MI 48362-3189
Mailing address
790 Remington Blvd
Bolingbrook, IL 60440-4909
Phone (630) 296-2222
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MI
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20200814002851 | MI | DME Supplier - Independently-Practicing Physical Therapist | 6204730393 | Practice locations: Lake Orion, MI |
Other NPIs with the same Medicare PAC ID 1
NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).
-
dba ATI Physical Therapy
- Physical Therapist
- Fowlerville, MI
- NPI 1669531166
6204730393
National Provider Directory
National Provider Directory- Tax ID family
- Ati Physical Therapy
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
-
dba ATI Physical Therapy
- Physical Therapist
- Fowlerville, MI
- NPI 1669531166
Member of 2
Organizations this organization is a member of, according to the National Provider Directory.
-
dba ATI Physical Therapy
- Physical Therapist
- Chicago, IL
- NPI 1205924354
Member Of
-
dba ATI Physical Therapy
- Durable Medical Equipment & Medical Supplies
- Forest Hill, MD
- NPI 1013109099
Member Of
Locations
425 N Park Blvd
Ste 100
Lake Orion, MI 48362
Phone (248) 693-6835
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1591920000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1737676800000",
"number": "1356966683",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "790 REMINGTON BLVD",
"city": "BOLINGBROOK",
"state": "IL",
"postal_code": "604404909",
"telephone_number": "630-296-2222"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "425 N PARK BLVD STE 100",
"city": "LAKE ORION",
"state": "MI",
"postal_code": "483623189",
"telephone_number": "248-693-6835"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "MICHIGAN REHABILITATION SPECIALISTS OF FOWLERVILLE, LLC",
"organizational_subpart": "NO",
"enumeration_date": "2020-06-12",
"last_updated": "2025-01-24",
"certification_date": "2025-01-24",
"status": "A",
"authorized_official_last_name": "MEYER",
"authorized_official_first_name": "WADE",
"authorized_official_middle_name": "A",
"authorized_official_title_or_position": "VP CHIEF COMPLIANCE OFFICER",
"authorized_official_telephone_number": "630-296-2222"
},
"taxonomies": [
{
"code": "332B00000X",
"taxonomy_group": "",
"desc": "Durable Medical Equipment & Medical Supplies",
"state": "NU",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lake Orion, MI
- Michigan Bone and Joint Center
- Michigan Gulf to Bay Anesthesiology Associates PSC
- Michigan Hearing, LLC
- Michigan Institute for Advanced Surgery Center, LLC (Michigan Institute for Advanced Surgery Center)
- Michigan Institute for Interventional Pain PLLC
- Migun S B G Services LLC
- Mariana Milan
- Millage Family Chiropractic
- Amy Miller
- Christine Stevens Mills
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 24, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.