Healthcare Provider Details

I. General information

NPI: 1205111465
Provider Name (Legal Business Name): THERAPY UNLIMITED, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2011
Last Update Date: 05/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44125 W TWELVE MILE ROAD E-123, BOX D7
NOVI MI
48377-1980
US

IV. Provider business mailing address

44125 W TWELVE MILE ROAD E-123, BOX D7
NOVI MI
48377-1980
US

V. Phone/Fax

Practice location:
  • Phone: 248-952-4340
  • Fax: 248-465-6059
Mailing address:
  • Phone: 248-952-4340
  • Fax: 248-465-6059

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number5501009589
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code261QX0100X
TaxonomyOccupational Medicine Clinic/Center
License Number5201009157
License Number StateMI

VIII. Authorized Official

Name: SUSAN KELLER
Title or Position: ADMINISTRATOR
Credential:
Phone: 248-952-4340