MEDICARE: PHYSIOLAB PHYSICAL THERAPY AND RECOVERY 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	:	1205538816
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHYSIOLAB PHYSICAL THERAPY AND RECOVERY LLC

Provider Business Mailing Address
First Line	:	25547 RIDGEWOOD DR
Second Line	:
City	:	FARMINGTON HILLS
State	:	MI
Zip	:	48336-1058
Country	:	US
Telephone Number	:	248-797-9359
Fax Number	:	248-479-0349

Provider Business Practice Location Address
First Line	:	8019 AGNES ST
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48214-2618
Country	:	US
Telephone Number	:	248-797-9359
Fax Number	:	248-479-0349

Authorized Official
Title or Position	:	OWNER/PHYSICAL THERAPIST
Name	:	SAMANTHA WENSON ZINNECKER
Credential	:	DPT
Telephone Number	:	248-797-9359

Provider Enumeration Date	:	03/20/2023
Last Update Date	:	05/11/2026

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