Healthcare Provider Details

I. General information

NPI: 1104437151
Provider Name (Legal Business Name): PHYSIOHQ LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2020
Last Update Date: 11/03/2020
Certification Date: 11/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3196 MONTICELLO LN
SAGINAW MI
48603-4815
US

IV. Provider business mailing address

3196 MONTICELLO LN
SAGINAW MI
48603-4815
US

V. Phone/Fax

Practice location:
  • Phone: 989-992-1251
  • Fax:
Mailing address:
  • Phone: 989-992-1251
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL KENNEDY
Title or Position: OWNER/THERAPIST
Credential: PT
Phone: 989-992-1251