Healthcare Provider Details

I. General information

NPI: 1881613750
Provider Name (Legal Business Name): THERAMAX
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

49050 SCHOENHERR RD SUITE 600
SHELBY TOWNSHIP MI
48315-3856
US

IV. Provider business mailing address

52700 FAIRCHILD RD
CHESTERFIELD MI
48051-1976
US

V. Phone/Fax

Practice location:
  • Phone: 586-566-8913
  • Fax:
Mailing address:
  • Phone: 586-949-7111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number5201000119
License Number StateMI

VIII. Authorized Official

Name: MS. LISA BERTHA WEINGARTZ
Title or Position: OCCUPATIONAL THERAPIST
Credential: OTR
Phone: 586-566-8913