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General NPI Number Information
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NPI Number | 1871938324
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Entity Type | Organization
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Legal Business Name | AWAKENING MOVEMENTS FELDENKRAIS AND PHYSICAL THERAPY
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Dates
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Enumeration Date | 05/09/2013
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Last Update Date | 06/20/2024
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Provider Practice Location Address
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Address Line | 1710 E 12 MILE RD STE 103
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City | ROYAL OAK
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State | MI
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Zip | 48073-4200
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Country | US
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Telephone | 248-321-0358
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Fax |
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Provider Business Mailing Address
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Address Line | 1775 E 14 MILE RD
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City | BIRMINGHAM
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State | MI
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Zip | 48009-7206
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Country | US
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Telephone | 248-321-0358
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Fax |
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Authorized Official
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Title or Position | PHYSICAL THERAPIST
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Name | MISS LISA DARLENE PONICHTER
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Credential | MPT, GCFP
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Telephone | 248-321-0358
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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 | 5501010870
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License Number State | MI
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