MEDICARE: HQ OF BLOOMFIELD TWP LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist
2	261QP2000X	Physical Therapy Clinic/Center

General Provider Information

NPI Number	:	1124853841
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HQ OF BLOOMFIELD TWP LLC

Provider Business Mailing Address
First Line	:	1773 STAR BATT DR
Second Line	:
City	:	ROCHESTER HILLS
State	:	MI
Zip	:	48309-3708
Country	:	US
Telephone Number	:	248-601-9207
Fax Number	:

Provider Business Practice Location Address
First Line	:	6614 TELEGRAPH RD
Second Line	:
City	:	BLOOMFIELD HILLS
State	:	MI
Zip	:	48301-3012
Country	:	US
Telephone Number	:	248-601-9207
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JULIE MARTEL
Credential	:
Telephone Number	:	248-408-6004

Provider Enumeration Date	:	09/03/2024
Last Update Date	:	11/04/2024

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Directions to “HQ OF BLOOMFIELD TWP LLC ” Practice Location

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