MEDICARE: MIDWEST PHYSICAL THERAPY INC

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	261QR0400X	Rehabilitation Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	71010000030767	OTHER	MI	BCBS

General Provider Information

NPI Number	:	1427084169
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MIDWEST PHYSICAL THERAPY INC

Provider Business Mailing Address
First Line	:	2220 TELEGRAPH RD
Second Line	:
City	:	DEARBORN
State	:	MI
Zip	:	48128
Country	:	US
Telephone Number	:	734-730-0062
Fax Number	:	734-730-2152

Provider Business Practice Location Address
First Line	:	2220 TELEGRAPH RD
Second Line	:
City	:	DEARBORN
State	:	MI
Zip	:	48128
Country	:	US
Telephone Number	:	734-730-0062
Fax Number	:	734-730-2152

Authorized Official
Title or Position	:	ADMINISTRATOR OWNER
Name	:	MANSOOR HAROON
Credential	:	PTA
Telephone Number	:	734-730-0062

Provider Enumeration Date	:	06/24/2006
Last Update Date	:	08/22/2020

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Directions to “MIDWEST PHYSICAL THERAPY INC ” Practice Location

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