Healthcare Provider Details

I. General information

NPI: 1588444574
Provider Name (Legal Business Name): ZACHARY ATWOOD PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2023
Last Update Date: 10/06/2024
Certification Date: 10/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36600 PLYMOUTH RD
LIVONIA MI
48150-1127
US

IV. Provider business mailing address

36600 PLYMOUTH RD
LIVONIA MI
48150-1127
US

V. Phone/Fax

Practice location:
  • Phone: 248-814-2029
  • Fax:
Mailing address:
  • Phone: 248-814-2029
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number5501021654
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number5501021654
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: