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General NPI Number Information
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NPI Number | 1073863874
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Entity Type | Organization
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Legal Business Name | MASTERCARE PHYSICAL THERAPY AND WELLNESS CENTER LLC
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Dates
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Enumeration Date | 09/19/2012
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Last Update Date | 09/19/2012
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Provider Practice Location Address
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Address Line | 6909 HIGHLAND RD SUITE B
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City | WATERFORD
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State | MI
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Zip | 48327-1648
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Country | US
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Telephone | 248-674-5277
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Fax | 248-674-5871
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Provider Business Mailing Address
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Address Line | 6909 HIGHLAND RD SUITE B
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City | WATERFORD
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State | MI
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Zip | 48327-1648
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Country | US
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Telephone | 248-674-5277
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Fax | 248-674-5871
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Authorized Official
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Title or Position | OWNER
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Name | MS. SUSAN JOHNSON
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Credential | PT
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Telephone | 248-494-3873
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 5501300653
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License Number State | MI
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