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General NPI Number Information
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NPI Number | 1174774541
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Entity Type | Organization
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Legal Business Name | POISE LLC
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Dates
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Enumeration Date | 10/03/2008
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Last Update Date | 02/24/2009
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Provider Practice Location Address
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Address Line | 186 E MAIN ST STE 301 SUITE 301
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City | NORTHVILLE
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State | MI
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Zip | 48167-2676
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Country | US
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Telephone | 248-349-3100
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Fax | 248-349-4040
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Provider Business Mailing Address
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Address Line | 186 E MAIN ST STE 301 SUITE 301
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City | NORTHVILLE
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State | MI
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Zip | 48167-2676
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Country | US
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Telephone | 248-349-3100
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Fax | 248-349-4040
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Authorized Official
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Title or Position | OWNER
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Name | MRS. HEIDI STEINKE MALZAHN
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Credential |
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Telephone | 248-349-3100
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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 | 5501011498
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License Number State | MI
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