MEDICARE: STERLING THERAPY PROVIDER, 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	5501011330	MI

General Provider Information

NPI Number	:	1659500296
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STERLING THERAPY PROVIDER, LLC

Provider Business Mailing Address
First Line	:	38765 MOUND RD
Second Line	:	STE. 101
City	:	STERLING HEIGHTS
State	:	MI
Zip	:	48310-3209
Country	:	US
Telephone Number	:	586-274-0750
Fax Number	:	586-274-0704

Provider Business Practice Location Address
First Line	:	38765 MOUND RD
Second Line	:	STE. 101
City	:	STERLING HEIGHTS
State	:	MI
Zip	:	48310-3209
Country	:	US
Telephone Number	:	586-274-0750
Fax Number	:	586-274-0704

Authorized Official
Title or Position	:	PRESIDENT/CEO
Name	:	MR. ROLLY ELACO G ELACO
Credential	:	PHYSICAL THERAPIST
Telephone Number	:	313-729-0799

Provider Enumeration Date	:	07/02/2009
Last Update Date	:	07/02/2009

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