MEDICARE: NEW LIFE PHYSICAL THERAPY SERVICES 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	5501012206	MI

General Provider Information

NPI Number	:	1609152339
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEW LIFE PHYSICAL THERAPY SERVICES LLC

Provider Business Mailing Address
First Line	:	25529 VAN DYKE AVE
Second Line	:	SUITE A-1
City	:	CENTER LINE
State	:	MI
Zip	:	48015-1848
Country	:	US
Telephone Number	:	586-782-7061
Fax Number	:

Provider Business Practice Location Address
First Line	:	25529 VAN DYKE AVE
Second Line	:	SUITE A-1
City	:	CENTER LINE
State	:	MI
Zip	:	48015-1848
Country	:	US
Telephone Number	:	586-782-7061
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. NIRAV ANILKUMAR SHAH
Credential	:	RPT
Telephone Number	:	586-782-7061

Provider Enumeration Date	:	10/26/2011
Last Update Date	:	10/26/2011

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