MEDICARE: PREMIER THERAPY CENTERS, 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	225X00000X	Occupational Therapist
2	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1699200204
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PREMIER THERAPY CENTERS, INC.

Provider Business Mailing Address
First Line	:	33010 NORTHWESTERN HWY
Second Line	:
City	:	WEST BLOOMFIELD
State	:	MI
Zip	:	48322-3690
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1001 WELCH RD
Second Line	:	SUITE 104
City	:	COMMERCE TOWNSHIP
State	:	MI
Zip	:	48390-2864
Country	:	US
Telephone Number	:	248-956-7640
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	NORA CASCARDO
Credential	:
Telephone Number	:	248-956-7640

Provider Enumeration Date	:	04/21/2017
Last Update Date	:	04/21/2017

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