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General NPI Number Information
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NPI Number | 1174832083
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Entity Type | Organization
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Legal Business Name | PRO-MOTION PHYSICAL THERAPY, PLLC
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Dates
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Enumeration Date | 09/27/2010
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Last Update Date | 12/28/2010
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Provider Practice Location Address
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Address Line | 205 W GRAND RIVER AVE STE 201
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City | BRIGHTON
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State | MI
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Zip | 48116-1647
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Country | US
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Telephone | 248-514-3112
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Fax |
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Provider Business Mailing Address
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Address Line | 6412 BLACK WALNUT ST
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City | BRIGHTON
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State | MI
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Zip | 48116-6724
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | VINCENT PAUL BAYLERIAN
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Credential |
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Telephone | 248-514-3112
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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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