Great Northern Rehab P C
Organization Active NPI Physical Therapist · Ironwood, MI
NPI 1386937530 · NPPES record last updated Apr 30, 2012
Key facts
- NPI
- 1386937530
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Physical Therapist 225100000X
- Legal business name
- GREAT NORTHERN REHAB P C
- Practice address
- 1310 E Cloverland Dr
Ironwood, MI 49938-1606 - Phone
- (906) 932-4200
- Fax
- (906) 932-4201
- NPI assigned
- May 20, 2011
- Organization subpart
- No
Authorized official
- Name
- Mr. Richard W Shutes
- Title
- Ceo/President
- Phone
- (352) 732-8868
Practitioners 7
-
Shawn Edyvean, PT
-
Dana Lynn Leannah, MOT, OTR/L
-
Rebecca Lynn Mika, OTR
-
Monica Therese Kutz, OTR
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MI
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20111028000643 | MI | Part B Supplier - Physical/Occupational Therapy Group in Private Practice | 8729251269 |
Receives reassigned benefits from 2 practitioners Practice locations: Ironwood, MI |
National Provider Directory
Locations
1310 E Cloverland Dr
Ironwood, MI 49938
Phone (906) 932-4200
930 E Cloverland Dr
Ironwood, MI 49938
Phone (906) 932-4200
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist |
225100000X | Yes | ||
| Occupational Therapist |
225X00000X |
Addresses
Primary practice location
1310 E Cloverland Dr
Ironwood, MI 49938-1606
Mailing address
2620 SE Maricamp Rd
Ocala, FL 34471-5582
Phone (352) 732-8868
Other providers in Ironwood, MI
- Jamie Leah Fiorucci
- Kathryn Ann Fredianelli
- Wes L Frisbey
- Sarah Gille
- Great Lakes Recovery Centers
- Stanley Weir Gresham
- Jane Gruenke
- Allison Harr
- Susanna Lee Harris
- Billie Jo Hellen
All providers in Ironwood, MI · Physical Therapist in Michigan
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 30, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.