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General NPI Number Information
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NPI Number | 1861908865
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Entity Type | Organization
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Legal Business Name | REFINE PHYSICAL THERAPY LLC
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Dates
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Enumeration Date | 12/28/2017
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Last Update Date | 12/28/2017
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Provider Practice Location Address
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Address Line | 555 S OLD WOODWARD AVE
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City | BIRMINGHAM
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State | MI
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Zip | 48009-6658
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Country | US
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Telephone | 517-303-0138
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Fax |
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Provider Business Mailing Address
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Address Line | 2715 BEMBRIDGE RD
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City | ROYAL OAK
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State | MI
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Zip | 48073-2922
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Country | US
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Telephone | 517-303-0138
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Fax |
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Authorized Official
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Title or Position | PHYSICAL THERAPIST/OWNER
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Name | MANDY MA
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Credential | DPT
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Telephone | 517-303-0138
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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 | 5501017061
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License Number State | MI
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