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General NPI Number Information
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NPI Number | 1053610618
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Entity Type | Organization
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Legal Business Name | FITNESS PHYSICAL THERAPY LLC
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Dates
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Enumeration Date | 03/22/2011
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Last Update Date | 03/22/2011
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Provider Practice Location Address
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Address Line | 6455 GRATIOT AVE
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City | DETROIT
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State | MI
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Zip | 48207-1808
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Country | US
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Telephone | 313-921-8600
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Fax | 313-921-1712
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Provider Business Mailing Address
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Address Line | 2299 SAINT JOSEPH ST
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City | WEST BLOOMFIELD
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State | MI
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Zip | 48324-1869
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Country | US
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Telephone | 248-520-6860
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Fax | 248-706-1562
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. SHAHJEHAN ANWAR JAURA
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Credential |
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Telephone | 248-520-6860
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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