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General NPI Number Information
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NPI Number | 1518184969
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Entity Type | Organization
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Legal Business Name | UZNIS PHYSICAL THERAPY
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Dates
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Enumeration Date | 04/19/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 18101 E WARREN AVE
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City | DETROIT
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State | MI
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Zip | 48224-1382
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Country | US
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Telephone | 313-881-5678
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Fax | 313-881-9337
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Provider Business Mailing Address
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Address Line | 22909 SOCIA ST
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City | SAINT CLAIR SHORES
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State | MI
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Zip | 48082-3029
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Country | US
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Telephone | 586-850-5947
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Fax |
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Authorized Official
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Title or Position | PHYSICAL THERAPIST
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Name | JACQUELINE R VANEECKE
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Credential | PT
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Telephone | 313-881-5678
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 5501008061
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License Number State | MI
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