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General NPI Number Information
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NPI Number | 1144766072
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Entity Type | Organization
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Legal Business Name | ROSE PHYSICAL THERAPY
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Dates
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Enumeration Date | 01/17/2017
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Last Update Date | 01/17/2017
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Provider Practice Location Address
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Address Line | 42630 VAN DYKE AVE
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City | STERLING HEIGHTS
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State | MI
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Zip | 48314-3324
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Country | US
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Telephone | 586-930-1836
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Fax | 586-930-1837
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Provider Business Mailing Address
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Address Line | 42630 VAN DYKE AVE
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City | STERLING HEIGHTS
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State | MI
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Zip | 48314-3324
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Country | US
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Telephone | 586-930-1836
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Fax | 586-930-1837
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Authorized Official
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Title or Position | AUTHORIZED OFFICIAL
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Name | ARAK ISHAQ
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Credential |
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Telephone | 586-930-1836
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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 |
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License Number State |
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