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General NPI Number Information
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NPI Number | 1881193514
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Entity Type | Organization
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Legal Business Name | DETROIT HEALING HANDS PHYSICAL THERAPY CENTER, LLC
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Dates
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Enumeration Date | 02/08/2018
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Last Update Date | 02/08/2018
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Provider Practice Location Address
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Address Line | 19522 W MCNICHOLS RD STE E
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City | DETROIT
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State | MI
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Zip | 48219-4090
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Country | US
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Telephone | 313-727-1330
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Fax |
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Provider Business Mailing Address
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Address Line | 1866 DORCHESTER DR N APT 204
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City | TROY
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State | MI
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Zip | 48084-8317
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Country | US
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Telephone | 313-520-6714
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | TIMOTHY JACKOSN
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Credential |
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Telephone | 313-520-6714
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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 | MI
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