Healthcare Provider Details

I. General information

NPI: 1134422363
Provider Name (Legal Business Name): 1ST PRIORITY PHYSICAL THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/09/2010
Last Update Date: 12/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21700 GREENFIELD RD
OAK PARK MI
48237-2581
US

IV. Provider business mailing address

21700 GREENFIELD RD
OAK PARK MI
48237-2581
US

V. Phone/Fax

Practice location:
  • Phone: 248-968-6899
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. MALIK FUQUA
Title or Position: OWNER
Credential:
Phone: 248-968-6899