MEDICARE: ARCHANGELS PHYSICAL THERAPY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2000X	Physical Therapy Clinic/Center

General Provider Information

NPI Number	:	1033686803
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ARCHANGELS PHYSICAL THERAPY

Provider Business Mailing Address
First Line	:	3900 18 MILE RD
Second Line	:
City	:	STERLING HEIGHTS
State	:	MI
Zip	:	48314-3826
Country	:	US
Telephone Number	:	586-393-5431
Fax Number	:

Provider Business Practice Location Address
First Line	:	3900 18 MILE RD
Second Line	:
City	:	STERLING HEIGHTS
State	:	MI
Zip	:	48314-3826
Country	:	US
Telephone Number	:	586-393-5431
Fax Number	:

Authorized Official
Title or Position	:	BILLER
Name	:	MONA KASHAT
Credential	:
Telephone Number	:	619-647-1603

Provider Enumeration Date	:	10/30/2018
Last Update Date	:	10/30/2018

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Directions to “ARCHANGELS PHYSICAL THERAPY ” Practice Location

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