Healthcare Provider Details

I. General information

NPI: 1104655810
Provider Name (Legal Business Name): HQ OF BLOOMFIELD HILLS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2024
Last Update Date: 07/31/2024
Certification Date: 07/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 W BIG BEAVER RD STE 125
BLOOMFIELD HILLS MI
48304-3915
US

IV. Provider business mailing address

1773 STAR BATT DR
ROCHESTER HILLS MI
48309-3708
US

V. Phone/Fax

Practice location:
  • Phone: 248-309-8900
  • Fax:
Mailing address:
  • Phone: 248-601-9207
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: JULIE MARTEL
Title or Position: OWNER
Credential:
Phone: 248-408-6004