Provider Demographics
NPI:1306244066
Name:PREMIER REHABILITATION
Entity type:Organization
Organization Name:PREMIER REHABILITATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER/PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:TYLER
Authorized Official - Middle Name:
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:517-709-4677
Mailing Address - Street 1:2380 CEDAR ST
Mailing Address - Street 2:SUITE 203
Mailing Address - City:HOLT
Mailing Address - State:MI
Mailing Address - Zip Code:48842-2143
Mailing Address - Country:US
Mailing Address - Phone:517-709-4677
Mailing Address - Fax:517-798-5667
Practice Address - Street 1:2380 CEDAR ST
Practice Address - Street 2:SUITE 203
Practice Address - City:HOLT
Practice Address - State:MI
Practice Address - Zip Code:48842-2143
Practice Address - Country:US
Practice Address - Phone:517-709-4677
Practice Address - Fax:517-798-5667
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-11
Last Update Date:2021-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty