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General NPI Number Information
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NPI Number | 1477369445
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Entity Type | Organization
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Legal Business Name | MOBILIZE PHYSICAL THERAPY
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Dates
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Enumeration Date | 12/05/2024
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Last Update Date | 12/05/2024
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Provider Practice Location Address
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Address Line | 1695 12 MILE RD SUITE 200A
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City | BERKLEY
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State | MI
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Zip | 48072
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Country | US
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Telephone | 248-909-5302
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Fax |
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Provider Business Mailing Address
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Address Line | 5382 MIDCHESTER CT
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City | WEST BLOOMFIELD
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State | MI
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Zip | 48324-1162
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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 | OWNER
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Name | JAN SHAIK
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Credential |
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Telephone | 248-909-5302
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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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