Healthcare Provider Details

I. General information

NPI: 1053774307
Provider Name (Legal Business Name): ASSOCIATED PHYSICAL THERAPY SERVICES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2016
Last Update Date: 08/01/2023
Certification Date: 08/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27200 LAHSER RD STE 200
SOUTHFIELD MI
48034
US

IV. Provider business mailing address

27200 LAHSER RD STE 200
SOUTHFIELD MI
48034
US

V. Phone/Fax

Practice location:
  • Phone: 248-208-9215
  • Fax: 248-208-9217
Mailing address:
  • Phone: 248-208-9215
  • Fax: 248-208-9217

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number5501005895
License Number StateMI

VIII. Authorized Official

Name: TESSY JENKINS
Title or Position: OWNER
Credential: M.D.
Phone: 248-208-9215