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General NPI Number Information
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NPI Number | 1922154657
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Entity Type | Organization
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Legal Business Name | FIZIOSTIM REHABILITATION LLC
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Dates
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Enumeration Date | 01/26/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 26699 W 12 MILE RD STE 202
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City | SOUTHFIELD
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State | MI
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Zip | 48034-7815
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Country | US
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Telephone | 248-353-3260
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Fax | 248-353-3275
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Provider Business Mailing Address
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Address Line | 26699 W 12 MILE RD STE 202
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City | SOUTHFIELD
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State | MI
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Zip | 48034-7815
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Country | US
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Telephone | 248-353-3260
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Fax | 248-353-3275
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. VIVEK SHIRISHKAR
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Credential | RPT
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Telephone | 248-353-3260
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 5501006078
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License Number State | MI
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