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General NPI Number Information
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NPI Number | 1316536113
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Entity Type | Organization
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Legal Business Name | PRIVATE HEALTH PHYSICAL THERAPY & WELLNESS, PLC
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Dates
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Enumeration Date | 01/15/2021
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Last Update Date | 02/07/2023
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Provider Practice Location Address
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Address Line | 28345 BECK RD STE 412
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City | WIXOM
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State | MI
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Zip | 48393-4745
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Country | US
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Telephone | 248-308-0400
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Fax |
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Provider Business Mailing Address
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Address Line | 25450 VILLAGEWOOD CT
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City | SOUTH LYON
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State | MI
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Zip | 48178-8041
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Country | US
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Telephone | 248-308-0400
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Fax |
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Authorized Official
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Title or Position | FOUNDER/OWNER
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Name | CHRISTA MILENA CARLOMUSTO
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Credential | PT, MPT
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Telephone | 248-308-0400
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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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