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General NPI Number Information
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NPI Number | 1013044569
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Entity Type | Organization
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Legal Business Name | THERASPORT PHYSICAL THERAPY, INC.
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Dates
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Enumeration Date | 02/28/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 6543 MIDDLEBELT RD
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City | GARDEN CITY
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State | MI
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Zip | 48135-2145
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Country | US
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Telephone | 734-458-7878
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Fax | 734-458-7838
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Provider Business Mailing Address
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Address Line | 3425 EXECUTIVE PKWY SUITE 128
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City | TOLEDO
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State | OH
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Zip | 43606-1326
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Country | US
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Telephone | 419-252-5541
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Fax | 419-252-5548
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Authorized Official
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Title or Position | VICE PRESIDENT - REIMBURSEMENTS
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Name | MR. BARRY A LAZARUS
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Credential |
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Telephone | 419-252-5541
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0400X
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Taxonomy Name | Rehabilitation Clinic/Center
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License Number |
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License Number State |
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