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General NPI Number Information
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NPI Number | 1245747401
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Entity Type | Organization
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Legal Business Name | EVIDENCE IN MANUAL PHYSICAL THERAPY LLC
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Dates
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Enumeration Date | 01/09/2018
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Last Update Date | 04/23/2021
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Provider Practice Location Address
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Address Line | 39070 VAN DYKE AVE
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City | STERLING HEIGHTS
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State | MI
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Zip | 48313-4613
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Country | US
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Telephone | 248-688-5601
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Fax |
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Provider Business Mailing Address
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Address Line | 6634 CHATHAM CIR
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City | ROCHESTER HILLS
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State | MI
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Zip | 48306-4383
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Country | US
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Telephone | 248-688-5601
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. ISHAK ADEL YANNI
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Credential | DPT
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Telephone | 248-688-5601
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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 | 5501014924
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License Number State | MI
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