MEDICARE: MICHIGAN PHYSICAL THERAPY GROUP, 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	261QP2000X	Physical Therapy Clinic/Center

General Provider Information

NPI Number	:	1285124412
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MICHIGAN PHYSICAL THERAPY GROUP, LLC

Provider Business Mailing Address
First Line	:	13530 MICHIGAN AVE STE 245
Second Line	:
City	:	DEARBORN
State	:	MI
Zip	:	48126-3575
Country	:	US
Telephone Number	:	212-414-1111
Fax Number	:

Provider Business Practice Location Address
First Line	:	13530 MICHIGAN AVE STE 245
Second Line	:
City	:	DEARBORN
State	:	MI
Zip	:	48126-3575
Country	:	US
Telephone Number	:	212-414-1111
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MR. MICHAEL FRANK PAPIO JR.
Credential	:
Telephone Number	:	212-414-1111

Provider Enumeration Date	:	05/14/2018
Last Update Date	:	09/25/2019

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