Healthcare Provider Details

I. General information

NPI: 1003139148
Provider Name (Legal Business Name): MICHIGAN CENTER FOR PHYSICAL THERAPY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/03/2010
Last Update Date: 09/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30770 SOUTHFIELD RD
SOUTHFIELD MI
48076-7739
US

IV. Provider business mailing address

30770 SOUTHFIELD RD
SOUTHFIELD MI
48076-7739
US

V. Phone/Fax

Practice location:
  • Phone: 248-885-8161
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number
License Number State

VIII. Authorized Official

Name: JAY ROSETT
Title or Position: PRESIDENT
Credential:
Phone: 248-798-5000