Healthcare Provider Details

I. General information

NPI: 1619172673
Provider Name (Legal Business Name): CKS OF MT CLEMENS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2007
Last Update Date: 01/26/2023
Certification Date: 01/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

243 CASS AVE
MOUNT CLEMENS MI
48043-2124
US

IV. Provider business mailing address

1773 STAR BATT DR
ROCHESTER HILLS MI
48309-3708
US

V. Phone/Fax

Practice location:
  • Phone: 586-783-7590
  • Fax:
Mailing address:
  • Phone: 248-601-9207
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number StateMI

VIII. Authorized Official

Name: JULIE MARTEL
Title or Position: OWNER
Credential:
Phone: 248-601-9207