Healthcare Provider Details

I. General information

NPI: 1649205121
Provider Name (Legal Business Name): METROPOLITAN PHYSICAL THERAPY AGENCY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 10/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13636 DIX TOLEDO RD SUITE B
SOUTHGATE MI
48195-2432
US

IV. Provider business mailing address

13636 DIX TOLEDO RD SUITE B
SOUTHGATE MI
48195-2432
US

V. Phone/Fax

Practice location:
  • Phone: 734-283-2262
  • Fax: 248-808-6268
Mailing address:
  • Phone: 734-283-2262
  • Fax: 248-808-6268

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number1482188
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number StateMI

VIII. Authorized Official

Name: MS. HINA T QAZI
Title or Position: PRESIDENT
Credential:
Phone: 734-512-8009