MEDICARE: BLACK STAR PHYSICAL THERAPY AND WELLNESS 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	2251X0800X	Orthopedic Physical Therapist

General Provider Information

NPI Number	:	1467284612
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BLACK STAR PHYSICAL THERAPY AND WELLNESS LLC

Provider Business Mailing Address
First Line	:	6403 WOODSIDE CT
Second Line	:
City	:	VAN BUREN TOWNSHIP
State	:	MI
Zip	:	48111-5142
Country	:	US
Telephone Number	:	716-523-8116
Fax Number	:

Provider Business Practice Location Address
First Line	:	6403 WOODSIDE CT
Second Line	:
City	:	VAN BUREN TOWNSHIP
State	:	MI
Zip	:	48111-5142
Country	:	US
Telephone Number	:	716-523-8116
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	NATASHA TAYLOR
Credential	:	PT
Telephone Number	:	716-523-8116

Provider Enumeration Date	:	08/16/2024
Last Update Date	:	08/16/2024

Similar Medicare Providers

1033325451 — NATASHA ANGTUOKUU TAYLOR PT, MS OCS
Practice Location Address:

6403 WOODSIDE CT
VAN BUREN TOWNSHIP, MI
48111-5142

Practice Phone: 734-644-3293
Practice Fax:

1790737799 — DR. HUSSEIN A HURAIBI M.D.
Practice Location Address:

11650 BELLEVILLE RD STE 101
VAN BUREN TOWNSHIP, MI
48111-3382

Practice Phone: 734-699-9888
Practice Fax: 734-325-6430

1265514244 — WAL-MART STORES EAST, LP
Practice Location Address:

10562 BELLEVILLE ROAD
VAN BUREN TOWNSHIP, MI
48111

Practice Phone: 734-697-2078
Practice Fax:

1639492812 — REESHEMAH K BURGESS FNP-BC
Practice Location Address:

847 SUMPTER RD # 494
VAN BUREN TOWNSHIP, MI
48111-4905

Practice Phone: 870-225-9558
Practice Fax:

1598081317 — MICHIGAN INSTITUTE OF PAIN MANAGEMENT WEST
Practice Location Address:

11650 BELLEVILLE ROAD
VAN BUREN TOWNSHIP, MI
48111

Practice Phone: 313-565-6782
Practice Fax: 313-565-6784

1841807294 — MS. COURTNEY ALANE EADDY-RICHARDSON PSYD
Practice Location Address:

16206 WESTLAKE CIR
VAN BUREN TOWNSHIP, MI
48111-6146

Practice Phone: 734-904-5075
Practice Fax:

Directions to “BLACK STAR PHYSICAL THERAPY AND WELLNESS LLC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.