Healthcare Provider Details

I. General information

NPI: 1346692621
Provider Name (Legal Business Name): MOUND PHYSICAL THERAPY & REHAB INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2016
Last Update Date: 07/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39501 MOUND RD
STERLING HEIGHTS MI
48310-2744
US

IV. Provider business mailing address

39501 MOUND RD
STERLING HEIGHTS MI
48310-2744
US

V. Phone/Fax

Practice location:
  • Phone: 586-883-6038
  • Fax: 586-883-6352
Mailing address:
  • Phone: 586-883-6038
  • Fax: 586-883-6352

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: NIKOLETA LISI
Title or Position: PRESIDENT
Credential:
Phone: 586-883-6038