Healthcare Provider Details

I. General information

NPI: 1033057674
Provider Name (Legal Business Name): ST JOHN PHYSICAL THERAPY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/24/2026
Last Update Date: 03/24/2026
Certification Date: 03/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28091 DEQUINDRE RD STE 200
MADISON HEIGHTS MI
48071-3047
US

IV. Provider business mailing address

28091 DEQUINDRE RD STE 200
MADISON HEIGHTS MI
48071-3047
US

V. Phone/Fax

Practice location:
  • Phone: 248-688-1186
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: MR. NABIL ELISHA
Title or Position: OWNER
Credential:
Phone: 586-209-8681