MEDICARE: ALLEN PHYSICAL THERAPY NOVI 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	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1538767728
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALLEN PHYSICAL THERAPY NOVI LLC

Provider Business Mailing Address
First Line	:	321 PETTIBONE ST STE 104
Second Line	:
City	:	SOUTH LYON
State	:	MI
Zip	:	48178-6000
Country	:	US
Telephone Number	:	248-437-2322
Fax Number	:	248-437-2433

Provider Business Practice Location Address
First Line	:	26850 PROVIDENCE PKWY STE 400
Second Line	:
City	:	NOVI
State	:	MI
Zip	:	48374-1263
Country	:	US
Telephone Number	:	248-468-4796
Fax Number	:	248-468-4793

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MRS. FRANCES ELIZABETH KUBACKI
Credential	:
Telephone Number	:	248-437-2322

Provider Enumeration Date	:	10/11/2020
Last Update Date	:	10/11/2020

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