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NPI Code Detail

MEDICARE: INTEGRATIVE PEDIATRIC THERAPY PLLC

MEDICARE: INTEGRATIVE PEDIATRIC THERAPY PLLC
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
1225X00000XOccupational Therapist
2235Z00000XSpeech-Language Pathologist
3251S00000XCommunity/Behavioral Health Agency
4261QH0700XHearing and Speech Clinic/Center
5103K00000XBehavior Analyst
6103T00000XPsychologist
7261Q00000XClinic/Center

General Provider Information

NPI Number : 1952945610
Entity Type Code : Organization
Provider Name (Legal Business Name) : INTEGRATIVE PEDIATRIC THERAPY PLLC
Provider Business Mailing Address
First Line : 19117 ALLEN RD STE C
Second Line :
City : BROWNSTOWN TWP
State : MI
Zip : 48183-1066
Country : US
Telephone Number : 734-720-7694
Fax Number :
Provider Business Practice Location Address
First Line : 19117 ALLEN RD STE C
Second Line :
City : BROWNSTOWN TWP
State : MI
Zip : 48183-1066
Country : US
Telephone Number : 734-720-7694
Fax Number :
Authorized Official
Title or Position : FOUNDER
Name : MANAL RIZK
Credential :
Telephone Number : 734-720-7694
Provider Enumeration Date : 11/05/2019
Last Update Date : 03/08/2021

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Directions to “INTEGRATIVE PEDIATRIC THERAPY PLLC ” Practice Location

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