MEDICARE: PHYSICAL THERAPY TEAM PC

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	261QP2000X	Physical Therapy Clinic/Center

General Provider Information

NPI Number	:	1437368131
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHYSICAL THERAPY TEAM PC

Provider Business Mailing Address
First Line	:	PO 21603
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48221
Country	:	US
Telephone Number	:	313-618-1041
Fax Number	:	248-553-8420

Provider Business Practice Location Address
First Line	:	1640 WEBB ST
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48206-1350
Country	:	US
Telephone Number	:	313-618-1041
Fax Number	:	248-991-1383

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	NATHANIEL DAVIS
Credential	:
Telephone Number	:	313-618-1041

Provider Enumeration Date	:	05/21/2007
Last Update Date	:	09/02/2008

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Directions to “PHYSICAL THERAPY TEAM PC ” Practice Location

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