Healthcare Provider Details

I. General information

NPI: 1215974613
Provider Name (Legal Business Name): EDUARDO A. ENRIQUEZ, P T PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2006
Last Update Date: 10/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

905 DEXTER ST
MILAN MI
48160-1160
US

IV. Provider business mailing address

905 DEXTER ST
MILAN MI
48160-1160
US

V. Phone/Fax

Practice location:
  • Phone: 734-439-8410
  • Fax: 734-439-8430
Mailing address:
  • Phone: 734-439-8410
  • Fax: 734-439-8430

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number225100000X
License Number StateMI

VIII. Authorized Official

Name: EDUARDO ALBERTO ENRIQUEZ
Title or Position: PHYSICAL THERAPIST/ OWNER
Credential: PT
Phone: 734-439-8410