MEDICARE: MOUND PHYSICAL THERAPY & REHAB INC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	225700000X	Massage Therapist
2	225X00000X	Occupational Therapist
3	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1346692621
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOUND PHYSICAL THERAPY & REHAB INC

Provider Business Mailing Address
First Line	:	39501 MOUND RD
Second Line	:
City	:	STERLING HEIGHTS
State	:	MI
Zip	:	48310-2744
Country	:	US
Telephone Number	:	586-883-6038
Fax Number	:	586-883-6352

Provider Business Practice Location Address
First Line	:	39501 MOUND RD
Second Line	:
City	:	STERLING HEIGHTS
State	:	MI
Zip	:	48310-2744
Country	:	US
Telephone Number	:	586-883-6038
Fax Number	:	586-883-6352

Authorized Official
Title or Position	:	PRESIDENT
Name	:	NIKOLETA LISI
Credential	:
Telephone Number	:	586-883-6038

Provider Enumeration Date	:	07/11/2016
Last Update Date	:	07/11/2016

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