MEDICARE: EVIDENCE IN MANUAL PHYSICAL THERAPY 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	5501014924	MI

General Provider Information

NPI Number	:	1245747401
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EVIDENCE IN MANUAL PHYSICAL THERAPY LLC

Provider Business Mailing Address
First Line	:	6634 CHATHAM CIR
Second Line	:
City	:	ROCHESTER HILLS
State	:	MI
Zip	:	48306-4383
Country	:	US
Telephone Number	:	248-688-5601
Fax Number	:

Provider Business Practice Location Address
First Line	:	39070 VAN DYKE AVE
Second Line	:
City	:	STERLING HEIGHTS
State	:	MI
Zip	:	48313-4613
Country	:	US
Telephone Number	:	248-688-5601
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. ISHAK ADEL YANNI
Credential	:	DPT
Telephone Number	:	248-688-5601

Provider Enumeration Date	:	01/09/2018
Last Update Date	:	04/23/2021

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