Healthcare Provider Details

I. General information

NPI: 1497268460
Provider Name (Legal Business Name): MUNGER PHYSICAL THERAPY OF CLINTON TOWNSHIP, PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2017
Last Update Date: 06/03/2024
Certification Date: 06/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44925 MORLEY DR
CLINTON TOWNSHIP MI
48036-1354
US

IV. Provider business mailing address

44925 MORLEY DR
CLINTON TOWNSHIP MI
48036-1354
US

V. Phone/Fax

Practice location:
  • Phone: 586-846-4320
  • Fax: 586-846-4326
Mailing address:
  • Phone: 868-464-3205
  • Fax: 586-846-4326

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MARKUS MICHAEL MUNGER
Title or Position: PT/OWNER
Credential: PT
Phone: 810-385-7405