Healthcare Provider Details

I. General information

NPI: 1861635179
Provider Name (Legal Business Name): TERANEH JEAN HUOTARI MPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2009
Last Update Date: 11/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27427 SCHOENHERR RD STE 200
WARREN MI
48088-4729
US

IV. Provider business mailing address

27427 SCHOENHERR RD STE 200
WARREN MI
48088-4729
US

V. Phone/Fax

Practice location:
  • Phone: 586-754-4417
  • Fax: 586-754-4473
Mailing address:
  • Phone: 586-754-4417
  • Fax: 586-754-4473

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5501010987
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: