Healthcare Provider Details

I. General information

NPI: 1073084661
Provider Name (Legal Business Name): JOHANNIE JOYCE APIL PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2018
Last Update Date: 12/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34505 W 12 MILE RD
FARMINGTON HILLS MI
48331-3258
US

IV. Provider business mailing address

62728 CRIMSON DR
WASHINGTON MI
48094-1743
US

V. Phone/Fax

Practice location:
  • Phone: 734-343-7500
  • Fax:
Mailing address:
  • Phone: 586-883-4043
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5501007385
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: