Provider Demographics
NPI:1396596250
Name:GREATER HEIGHTS PHYSICAL THERAPY AND PERFORMANCE LLC
Entity type:Organization
Organization Name:GREATER HEIGHTS PHYSICAL THERAPY AND PERFORMANCE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:GUY
Authorized Official - Middle Name:
Authorized Official - Last Name:BEACHNAU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:231-357-9173
Mailing Address - Street 1:PO BOX 279
Mailing Address - Street 2:
Mailing Address - City:OMENA
Mailing Address - State:MI
Mailing Address - Zip Code:49674-0279
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10783 E CHERRY BEND RD # 27
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-5249
Practice Address - Country:US
Practice Address - Phone:231-357-9173
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-28
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty