Provider Demographics
NPI:1588749022
Name:HRABINSKY, CLARENCE KELLY (PT)
Entity type:Individual
Prefix:MR
First Name:CLARENCE
Middle Name:KELLY
Last Name:HRABINSKY
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49253 HWY M26
Mailing Address - Street 2:
Mailing Address - City:HANCOCK
Mailing Address - State:MI
Mailing Address - Zip Code:49930
Mailing Address - Country:US
Mailing Address - Phone:906-483-0798
Mailing Address - Fax:
Practice Address - Street 1:901 W SHARON AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:HOUGHTON
Practice Address - State:MI
Practice Address - Zip Code:49931-1964
Practice Address - Country:US
Practice Address - Phone:906-483-4800
Practice Address - Fax:906-483-3972
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2007-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501006528225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIN72240002Medicare ID - Type Unspecified
MIN72240002Medicare PIN