Healthcare Provider Details

I. General information

NPI: 1730647421
Provider Name (Legal Business Name): PURE PHYSIOTHERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2019
Last Update Date: 03/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2155 WINSTON DR
COMMERCE TOWNSHIP MI
48382-4875
US

IV. Provider business mailing address

2155 WINSTON DR
COMMERCE TOWNSHIP MI
48382-4875
US

V. Phone/Fax

Practice location:
  • Phone: 313-414-9314
  • Fax:
Mailing address:
  • Phone: 313-414-9314
  • 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: MR. WILLIAM NILS THORNTON
Title or Position: PHYSICAL THERAPIST
Credential: PT, DPT
Phone: 313-414-9314