Healthcare Provider Details

I. General information

NPI: 1730363573
Provider Name (Legal Business Name): CRAWL WALK JUMP RUN THERAPY CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/27/2007
Last Update Date: 02/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43239 SCHOENHERR RD
STERLING HEIGHTS MI
48313-1957
US

IV. Provider business mailing address

43239 SCHOENHERR RD
STERLING HEIGHTS MI
48313-1957
US

V. Phone/Fax

Practice location:
  • Phone: 586-323-2957
  • Fax: 586-323-0022
Mailing address:
  • Phone: 586-323-2957
  • Fax: 586-323-0022

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MRS. STEPHANIE SERAFIMOVSKI
Title or Position: OWNER
Credential: MPT
Phone: 586-323-2957