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General NPI Number Information
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NPI Number | 1679185094
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Entity Type | Organization
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Legal Business Name | SPORTS CLUB PHYSICAL THERAPY PLLC
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Dates
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Enumeration Date | 08/18/2020
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Last Update Date | 08/18/2020
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Provider Practice Location Address
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Address Line | 6343 FARMINGTON RD
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City | W BLOOMFIELD
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State | MI
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Zip | 48322-2206
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Country | US
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Telephone | 248-227-9812
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Fax |
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Provider Business Mailing Address
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Address Line | 28634 LINCOLNVIEW DR
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City | FARMINGTON HILLS
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State | MI
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Zip | 48334-5250
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Country | US
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Telephone | 248-227-9812
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | BRAD OPPAT
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Credential |
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Telephone | 248-227-9812
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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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