Healthcare Provider Details

I. General information

NPI: 1467633677
Provider Name (Legal Business Name): ALL FORMS PHYSICAL THERAPY, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2007
Last Update Date: 11/15/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 LITTLE LAKE DR SUITE 4
ANN ARBOR MI
48103-6219
US

IV. Provider business mailing address

2516 HAMPSHIRE RD
ANN ARBOR MI
48104-6536
US

V. Phone/Fax

Practice location:
  • Phone: 734-222-7010
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5501012824
License Number StateMI

VIII. Authorized Official

Name: MOLLY JARIN
Title or Position: OWNER
Credential: MSPT
Phone: 734-222-7010