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General NPI Number Information
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NPI Number | 1992793442
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Entity Type | Organization
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Legal Business Name | TRISHARD P.C.
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Dates
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Enumeration Date | 10/10/2005
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Last Update Date | 03/14/2023
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Provider Practice Location Address
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Address Line | 2117 E 11 MILE RD
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City | WARREN
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State | MI
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Zip | 48092-3553
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Country | US
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Telephone | 586-573-4684
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Fax | 586-573-2575
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Provider Business Mailing Address
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Address Line | 2117 E 11 MILE RD
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City | WARREN
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State | MI
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Zip | 48092-3553
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Country | US
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Telephone | 586-573-4684
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Fax | 586-573-2575
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | PATRICIA ANN PANTELLI
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Credential | MA,CCC-SLP
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Telephone | 248-568-3563
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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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Taxonomy #2
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Taxonomy Code | 261QR0400X
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Taxonomy Name | Rehabilitation Clinic/Center
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License Number |
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License Number State | MI
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