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NPI Code Detail

MEDICARE: ANTHONY GAMM PT

MEDICARE: ANTHONY GAMM PT
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
1225100000XPhysical Therapist5501017283MI

General Provider Information

NPI Number : 1598132219
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANTHONY GAMM PT
Provider Business Mailing Address
First Line : 33900 HARPER AVE
Second Line : SUITE 104
City : CLINTON TOWNSHIP
State : MI
Zip : 48035-4258
Country : US
Telephone Number : 586-416-9100
Fax Number : 586-416-9103
Provider Business Practice Location Address
First Line : 32934 WOODWARD AVE
Second Line :
City : ROYAL OAK
State : MI
Zip : 48073-0957
Country : US
Telephone Number : 248-554-9201
Fax Number : 248-554-9202
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/28/2015
Last Update Date : 03/02/2022

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