Healthcare Provider Details

I. General information

NPI: 1720153430
Provider Name (Legal Business Name): PREFERRED PHYSICAL THERAPY SERVICES P C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2006
Last Update Date: 08/27/2020
Certification Date: 08/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5837 W VERNOR HWY
DETROIT MI
48209-2159
US

IV. Provider business mailing address

5837 W VERNOR HWY
DETROIT MI
48209-2159
US

V. Phone/Fax

Practice location:
  • Phone: 313-724-6336
  • Fax: 313-724-6379
Mailing address:
  • Phone: 313-724-6336
  • Fax: 313-724-6379

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: LORELEE JACINTO
Title or Position: PROVIDER
Credential: PT
Phone: 313-724-6336