MEDICARE: SPARTAN PHYSICAL THERAPY ,INC.

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	5501004932	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0F35778	OTHER	MI	BCBS PROVIDER NUMBER

General Provider Information

NPI Number	:	1952440497
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPARTAN PHYSICAL THERAPY ,INC.

Provider Business Mailing Address
First Line	:	56187 NICKELBY S
Second Line	:
City	:	SHELBY TOWNSHIP
State	:	MI
Zip	:	48316-5502
Country	:	US
Telephone Number	:	248-542-7440
Fax Number	:	248-545-4327

Provider Business Practice Location Address
First Line	:	28373 DEQUINDRE RD
Second Line	:
City	:	MADISON HTS
State	:	MI
Zip	:	48071-3003
Country	:	US
Telephone Number	:	248-542-7440
Fax Number	:	248-545-4327

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. SULTAN MAHMOOD
Credential	:	RPT
Telephone Number	:	248-542-7440

Provider Enumeration Date	:	02/05/2007
Last Update Date	:	09/24/2024

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