Healthcare Provider Details

I. General information

NPI: 1316134794
Provider Name (Legal Business Name): BACK TO MOTION WELLNESS CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2007
Last Update Date: 09/28/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32502 NORTHWESTERN HIGHWAY
FARMINGTON HILLS MI
48334-1446
US

IV. Provider business mailing address

32502 NORTHWESTERN HIGHWAY
FARMINGTON HILLS MI
48334-1446
US

V. Phone/Fax

Practice location:
  • Phone: 248-855-3900
  • Fax: 248-855-2996
Mailing address:
  • Phone: 248-855-3900
  • Fax: 248-855-2996

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251C2600X
TaxonomyCardiopulmonary Physical Therapist
License Number
License Number State

VIII. Authorized Official

Name: MS. TALA KHALF
Title or Position: PHYSICAL THERAPIST
Credential: MP OMPT
Phone: 248-855-3900