Healthcare Provider Details

I. General information

NPI: 1770056806
Provider Name (Legal Business Name): POWER PHYSICAL THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2019
Last Update Date: 02/12/2021
Certification Date: 02/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27789 MOUND RD
WARREN MI
48092-2697
US

IV. Provider business mailing address

PO BOX 880
STERLING HEIGHTS MI
48311-0880
US

V. Phone/Fax

Practice location:
  • Phone: 586-203-9888
  • Fax: 313-406-7255
Mailing address:
  • Phone: 727-422-4680
  • Fax: 313-406-7255

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: SAM HAKKI
Title or Position: MANAGER
Credential: MD
Phone: 727-422-4680