Healthcare Provider Details

I. General information

NPI: 1417872409
Provider Name (Legal Business Name): MAPLE PHYSICAL THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2026
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

47 W MAPLE RD
CLAWSON MI
48017-1109
US

IV. Provider business mailing address

47 W MAPLE RD
CLAWSON MI
48017-1109
US

V. Phone/Fax

Practice location:
  • Phone: 248-843-4553
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: WISAM AFAN
Title or Position: OWNER
Credential:
Phone: 248-843-4553