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General NPI Number Information
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NPI Number | 1326491358
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Entity Type | Organization
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Legal Business Name | MIPC PHYSICAL THERAPY
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Dates
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Enumeration Date | 07/14/2016
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Last Update Date | 07/14/2016
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Provider Practice Location Address
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Address Line | 19725 ALLEN RD BLDG 1 SUITE B
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City | BROWNSTOWN TWP
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State | MI
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Zip | 48183-1090
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Country | US
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Telephone | 734-225-8728
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Fax | 734-225-8726
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Provider Business Mailing Address
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Address Line | 21 STRATTON PL
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City | GROSSE POINTE SHORES
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State | MI
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Zip | 48236-1771
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Country | US
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Telephone | 313-727-5678
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Fax | 313-332-1955
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Authorized Official
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Title or Position | CHIEF FINANCIAL OFFICER
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Name | MS. CARLA HALADJIAN
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Credential |
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Telephone | 313-727-5678
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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 | 4301077632
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License Number State | MI
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