MEDICARE: PARKS DOWNRIVER PHYSICAL THERAPY 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	:	1922669928
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PARKS DOWNRIVER PHYSICAL THERAPY LLC

Provider Business Mailing Address
First Line	:	1770 FORT ST
Second Line	:
City	:	LINCOLN PARK
State	:	MI
Zip	:	48146-1904
Country	:	US
Telephone Number	:	248-739-6444
Fax Number	:

Provider Business Practice Location Address
First Line	:	1770 FORT ST
Second Line	:
City	:	LINCOLN PARK
State	:	MI
Zip	:	48146-1904
Country	:	US
Telephone Number	:	248-739-6444
Fax Number	:

Authorized Official
Title or Position	:	BILLER/MANAGER
Name	:	ALEX BAZZI
Credential	:
Telephone Number	:	248-739-6444

Provider Enumeration Date	:	06/21/2019
Last Update Date	:	09/22/2020

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