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General NPI Number Information
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NPI Number | 1710193370
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Entity Type | Organization
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Legal Business Name | PROFESSIONAL PHYSICAL THERAPY PC
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Dates
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Enumeration Date | 05/14/2007
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Last Update Date | 08/25/2009
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Provider Practice Location Address
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Address Line | 31150 HOOVER RD STE C
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City | WARREN
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State | MI
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Zip | 48093-7618
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Country | US
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Telephone | 586-268-1929
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Fax | 586-268-1933
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Provider Business Mailing Address
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Address Line | 31150 HOOVER RD STE C
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City | WARREN
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State | MI
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Zip | 48093-7618
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Country | US
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Telephone | 586-268-1929
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Fax | 586-268-1933
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Authorized Official
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Title or Position | PRESIDENT
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Name | VIKAS AHLUWALIA
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Credential | RPT
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Telephone | 586-268-1929
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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 | 5501005266
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License Number State | MI
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