Healthcare Provider Details

I. General information

NPI: 1902780711
Provider Name (Legal Business Name): PHYSICAL THERAPY SPECIALISTS OF DEARBORN LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2025
Last Update Date: 01/09/2026
Certification Date: 01/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14650 W WARREN AVE
DEARBORN MI
48126-1799
US

IV. Provider business mailing address

14650 W WARREN AVE
DEARBORN MI
48126-1799
US

V. Phone/Fax

Practice location:
  • Phone: 313-850-2918
  • Fax:
Mailing address:
  • Phone: 313-850-2918
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: SANDRA MITTEER
Title or Position: CREDENTIALING
Credential: CREDENTIALING
Phone: 616-581-6116