Healthcare Provider Details

I. General information

NPI: 1205200029
Provider Name (Legal Business Name): GENIE THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2015
Last Update Date: 11/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5680 TEQUESTA CT
W BLOOMFIELD MI
48323-2346
US

IV. Provider business mailing address

5680 TEQUESTA CT
W BLOOMFIELD MI
48323-2346
US

V. Phone/Fax

Practice location:
  • Phone: 313-701-0744
  • Fax:
Mailing address:
  • Phone: 313-701-0744
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DWENDE RIED
Title or Position: OWNER
Credential:
Phone: 313-701-0744