MEDICARE: DEVINNEY CZARNECKI PHYSICAL THERAPY PC

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	30619	OTHER		BCBS FACILITY ID

General Provider Information

NPI Number	:	1972672418
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DEVINNEY CZARNECKI PHYSICAL THERAPY PC

Provider Business Mailing Address
First Line	:	6020 W MAPLE RD
Second Line	:	SUITE 500
City	:	WEST BLOOMFIELD
State	:	MI
Zip	:	48322-4409
Country	:	US
Telephone Number	:	248-851-6999
Fax Number	:	248-851-6898

Provider Business Practice Location Address
First Line	:	6020 W MAPLE RD
Second Line	:	SUITE 500
City	:	WEST BLOOMFIELD
State	:	MI
Zip	:	48322-4409
Country	:	US
Telephone Number	:	248-851-6999
Fax Number	:	248-851-6898

Authorized Official
Title or Position	:	ADMINISTRATOR, OWNER, P.T.
Name	:	LOREN DEVINNEY
Credential	:	P.T., O.M.P.T.
Telephone Number	:	248-851-6999

Provider Enumeration Date	:	11/07/2006
Last Update Date	:	12/18/2012

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