Healthcare Provider Details

I. General information

NPI: 1487027215
Provider Name (Legal Business Name): HQ OF WEST BLOOMFIELD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2015
Last Update Date: 11/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4312 ORCHARD LAKE RD STE 100
WEST BLOOMFIELD MI
48323-1637
US

IV. Provider business mailing address

1773 STAR BATT DR
ROCHESTER HILLS MI
48309-3708
US

V. Phone/Fax

Practice location:
  • Phone: 248-788-6100
  • Fax:
Mailing address:
  • Phone: 248-601-9207
  • Fax: 248-650-8670

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: WILLIAM A KNIGHT
Title or Position: CEO
Credential:
Phone: 248-601-9207