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General NPI Number Information
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NPI Number | 1952945610
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Entity Type | Organization
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Legal Business Name | INTEGRATIVE PEDIATRIC THERAPY PLLC
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Dates
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Enumeration Date | 11/05/2019
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Last Update Date | 03/08/2021
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Provider Practice Location Address
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Address Line | 19117 ALLEN RD STE C
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City | BROWNSTOWN TWP
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State | MI
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Zip | 48183-1066
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Country | US
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Telephone | 734-720-7694
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Fax |
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Provider Business Mailing Address
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Address Line | 19117 ALLEN RD STE C
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City | BROWNSTOWN TWP
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State | MI
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Zip | 48183-1066
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Country | US
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Telephone | 734-720-7694
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Fax |
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Authorized Official
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Title or Position | FOUNDER
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Name | MANAL RIZK
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Credential |
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Telephone | 734-720-7694
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QH0700X
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Taxonomy Name | Hearing and Speech Clinic/Center
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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