Healthcare Provider Details

I. General information

NPI: 1316322803
Provider Name (Legal Business Name): MOVING FORWARD PHYSICAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2015
Last Update Date: 07/25/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

828 PEMBERTON RD
GROSSE POINTE PARK MI
48230-1730
US

IV. Provider business mailing address

828 PEMBERTON RD
GROSSE POINTE PARK MI
48230-1730
US

V. Phone/Fax

Practice location:
  • Phone: 313-815-7599
  • Fax: 313-432-0241
Mailing address:
  • Phone: 313-815-7599
  • Fax: 313-432-0241

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5501014039
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number5501014039
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number5501014039
License Number StateMI

VIII. Authorized Official

Name: KAREN R HOUTING
Title or Position: PHYSICAL THERAPIST
Credential: PT
Phone: 313-815-7599