MEDICARE: MICHIGAN PHYSICAL & OCCUPATIONAL THERAPY INC

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	:	1609408848
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MICHIGAN PHYSICAL & OCCUPATIONAL THERAPY INC

Provider Business Mailing Address
First Line	:	29273 DEQUINDRE RD
Second Line	:
City	:	MADISON HEIGHTS
State	:	MI
Zip	:	48071-4804
Country	:	US
Telephone Number	:	586-764-1922
Fax Number	:

Provider Business Practice Location Address
First Line	:	29273 DEQUINDRE RD
Second Line	:
City	:	MADISON HEIGHTS
State	:	MI
Zip	:	48071-4804
Country	:	US
Telephone Number	:	586-764-1922
Fax Number	:

Authorized Official
Title or Position	:	AUTHORIZED OFFICIAL
Name	:	LAMYA FAKHOURI
Credential	:
Telephone Number	:	586-764-1922

Provider Enumeration Date	:	02/05/2020
Last Update Date	:	02/05/2020

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