Provider Demographics
NPI:1306155742
Name:PRACTICAL REHABILITATION SERVICES, LLC
Entity type:Organization
Organization Name:PRACTICAL REHABILITATION SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:LAKE
Authorized Official - Suffix:
Authorized Official - Credentials:MA-CCC-SLP
Authorized Official - Phone:517-282-7779
Mailing Address - Street 1:PO BOX 794
Mailing Address - Street 2:
Mailing Address - City:OKEMOS
Mailing Address - State:MI
Mailing Address - Zip Code:48805-0794
Mailing Address - Country:US
Mailing Address - Phone:517-282-7779
Mailing Address - Fax:517-394-3604
Practice Address - Street 1:124 E WASHINGTON ST STE C
Practice Address - Street 2:
Practice Address - City:DEWITT
Practice Address - State:MI
Practice Address - Zip Code:48820-8826
Practice Address - Country:US
Practice Address - Phone:855-777-9297
Practice Address - Fax:517-394-3604
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-04
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty