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General NPI Number Information
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NPI Number | 1174177190
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Entity Type | Organization
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Legal Business Name | FAST TRACK PHYSICAL THERAPY & REHAB CENTER LLC
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Dates
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Enumeration Date | 07/29/2019
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Last Update Date | 03/11/2022
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Provider Practice Location Address
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Address Line | 43648 SCHOENHERR RD
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City | STERLING HEIGHTS
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State | MI
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Zip | 48313-1113
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Country | US
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Telephone | 586-604-9184
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Fax | 800-679-9769
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Provider Business Mailing Address
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Address Line | 43648 SCHOENHERR RD
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City | STERLING HEIGHTS
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State | MI
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Zip | 48313-1113
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Country | US
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Telephone | 248-420-3395
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | MARIA TERESA TRONGCO BANCOLITA-COOK
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Credential | PT
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Telephone | 586-604-9184
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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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