MEDICARE: RESURGENCE PHYSICAL THERAPY SERVICES 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	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1518692821
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RESURGENCE PHYSICAL THERAPY SERVICES PC

Provider Business Mailing Address
First Line	:	2258 PLUMGROVE LN
Second Line	:
City	:	WEST BLOOMFIELD
State	:	MI
Zip	:	48324-1465
Country	:	US
Telephone Number	:	734-834-1667
Fax Number	:

Provider Business Practice Location Address
First Line	:	6525 W MAPLE RD
Second Line	:	SUITE A
City	:	WEST BLOOMFIELD
State	:	MI
Zip	:	48322-4930
Country	:	US
Telephone Number	:	248-562-7846
Fax Number	:	248-562-7858

Authorized Official
Title or Position	:	PRESIDENT
Name	:	NIMESH SETH
Credential	:	DPT
Telephone Number	:	734-834-1667

Provider Enumeration Date	:	07/20/2022
Last Update Date	:	08/24/2022

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