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General NPI Number Information
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NPI Number | 1467904615
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Entity Type | Organization
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Legal Business Name | ADVANCED HEALTH ALLIANCE LLC
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Dates
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Enumeration Date | 11/03/2016
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Last Update Date | 11/03/2016
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Provider Practice Location Address
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Address Line | 395 N GROESBECK HWY SUITE L
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City | MOUNT CLEMENS
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State | MI
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Zip | 48043-1542
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Country | US
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Telephone | 586-630-0474
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Fax | 586-630-0476
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Provider Business Mailing Address
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Address Line | 395 N GROESBECK HWY SUITE L
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City | MOUNT CLEMENS
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State | MI
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Zip | 48043-1542
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Country | US
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Telephone | 586-630-0474
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Fax | 586-630-0476
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Authorized Official
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Title or Position | OWNER
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Name | MR. JULIAN MATTIA
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Credential |
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Telephone | 248-508-7550
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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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