MEDICARE: SANDIFRAN PT BLOOMFIELD LLC

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	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1144819830
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SANDIFRAN PT BLOOMFIELD LLC

Provider Business Mailing Address
First Line	:	33060 NORTHWESTERN HWY STE 110
Second Line	:
City	:	WEST BLOOMFIELD
State	:	MI
Zip	:	48322-3695
Country	:	US
Telephone Number	:	248-970-2136
Fax Number	:	248-970-2137

Provider Business Practice Location Address
First Line	:	33060 NORTHWESTERN HWY STE 110
Second Line	:
City	:	WEST BLOOMFIELD
State	:	MI
Zip	:	48322-3695
Country	:	US
Telephone Number	:	248-970-2136
Fax Number	:	248-970-2137

Authorized Official
Title or Position	:	OWNER
Name	:	SANDI FRANCIS
Credential	:
Telephone Number	:	248-970-2136

Provider Enumeration Date	:	01/16/2021
Last Update Date	:	01/20/2021

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