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General NPI Number Information
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NPI Number | 1639618267
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Entity Type | Organization
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Legal Business Name | PHYSICAL THERAPY MANAGEMENT MI LLC
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Dates
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Enumeration Date | 02/15/2017
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Last Update Date | 02/15/2017
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Provider Practice Location Address
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Address Line | 461 W HURON ST SUITE # G70
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City | PONTIAC
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State | MI
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Zip | 48341-1601
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Country | US
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Telephone | 248-747-3497
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Fax | 800-980-3329
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Provider Business Mailing Address
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Address Line | PO BOX 431361
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City | PONTIAC
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State | MI
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Zip | 48343-1361
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Country | US
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Telephone | 248-747-3497
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Fax | 800-980-3329
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Authorized Official
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Title or Position | OWNER
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Name | RAWAN SHKOUKANI
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Credential |
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Telephone | 586-202-6706
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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 |
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License Number State |
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