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General NPI Number Information
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NPI Number | 1811496359
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Entity Type | Organization
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Legal Business Name | SOUL PHYSICAL THERAPY CENTER
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Dates
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Enumeration Date | 02/11/2018
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Last Update Date | 02/11/2018
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Provider Practice Location Address
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Address Line | 6558 GREENFIELD RD
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City | DEARBORN
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State | MI
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Zip | 48126-1701
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Country | US
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Telephone | 313-581-1155
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Fax | 313-581-1144
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Provider Business Mailing Address
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Address Line | PO BOX 86
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City | DEARBORN
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State | MI
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Zip | 48121-0086
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Country | US
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Telephone | 313-581-1155
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Fax | 313-581-1144
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Authorized Official
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Title or Position | PRESIDENT/ MANAGER
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Name | AMENEH REZVAN
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Credential |
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Telephone | 248-884-0048
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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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