MEDICARE: PREMIER PHYSICAL THERAPY, P.C.

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	:	1609035435
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PREMIER PHYSICAL THERAPY, P.C.

Provider Business Mailing Address
First Line	:	5663 MIDDLESEX ST
Second Line	:
City	:	DEARBORN
State	:	MI
Zip	:	48126-2110
Country	:	US
Telephone Number	:	248-707-0299
Fax Number	:

Provider Business Practice Location Address
First Line	:	5663 MIDDLESEX ST
Second Line	:
City	:	DEARBORN
State	:	MI
Zip	:	48126-2110
Country	:	US
Telephone Number	:	248-707-0299
Fax Number	:

Authorized Official
Title or Position	:	OWNER/PRESIDENT
Name	:	MR. AHMED ABDALLAH SHRIEF
Credential	:	P.T.
Telephone Number	:	248-707-0299

Provider Enumeration Date	:	06/06/2008
Last Update Date	:	06/06/2008

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