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General NPI Number Information
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NPI Number | 1760533699
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Entity Type | Organization
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Legal Business Name | WAYNE COUNTY THERAPEUTIC, INC.
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Dates
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Enumeration Date | 01/16/2007
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 29510 7 MILE RD
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City | LIVONIA
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State | MI
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Zip | 48152-1910
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Country | US
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Telephone | 248-427-9525
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Fax | 248-427-9528
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Provider Business Mailing Address
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Address Line | 29510 7 MILE RD
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City | LIVONIA
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State | MI
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Zip | 48152-1910
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Country | US
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Telephone | 248-427-9525
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Fax | 248-427-9528
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Authorized Official
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Title or Position | OWNER
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Name | MISS BERNICE ALBERTA BROWN
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Credential | COTA
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Telephone | 248-354-6434
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number |
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License Number State |
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