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General NPI Number Information
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NPI Number | 1528123304
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Entity Type | Organization
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Legal Business Name | HERITAGE PHYSICAL THERAPY, PLLC
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Dates
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Enumeration Date | 12/22/2006
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Last Update Date | 10/15/2008
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Provider Practice Location Address
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Address Line | 2891 E MAPLE RD STE 103
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City | TROY
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State | MI
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Zip | 48083-6106
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Country | US
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Telephone | 248-720-0701
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Fax |
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Provider Business Mailing Address
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Address Line | 2891 E MAPLE RD STE 103
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City | TROY
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State | MI
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Zip | 48083-6106
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Country | US
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Telephone | 248-720-0701
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | ANTONI LODZINSKI
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Credential | PHD, P.T., A.T.C.
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Telephone | 248-366-0403
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0400X
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Taxonomy Name | Rehabilitation Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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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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