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General NPI Number Information
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NPI Number | 1760828131
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Entity Type | Organization
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Legal Business Name | OMNI KINETICS
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Dates
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Enumeration Date | 05/13/2013
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Last Update Date | 06/28/2013
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Provider Practice Location Address
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Address Line | 8768 N TERRITORIAL RD C/O FOX HILLS
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City | PLYMOUTH
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State | MI
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Zip | 48170-5022
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Country | US
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Telephone | 248-229-8628
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Fax |
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Provider Business Mailing Address
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Address Line | 3602 NORMANDY RD
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City | ROYAL OAK
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State | MI
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Zip | 48073-1651
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Country | US
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Telephone | 248-229-8628
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Fax |
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Authorized Official
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Title or Position | OWNER OPERATOR
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Name | MR. GRAHAM A POLAKOFF
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Credential | MS, ATC
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Telephone | 248-229-8628
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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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