Provider Demographics
NPI:1013230168
Name:EASTPOINTE PHYSICAL THERAPY
Entity Type:Organization
Organization Name:EASTPOINTE PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DOMINIC
Authorized Official - Middle Name:A
Authorized Official - Last Name:CUSUMANO
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:586-573-6669
Mailing Address - Street 1:28295 SCHOENHERR RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48088-4300
Mailing Address - Country:US
Mailing Address - Phone:586-573-6669
Mailing Address - Fax:576-573-6667
Practice Address - Street 1:42536 HAYES RD
Practice Address - Street 2:SUITE 100
Practice Address - City:CLINTON TWP
Practice Address - State:MI
Practice Address - Zip Code:48038-6766
Practice Address - Country:US
Practice Address - Phone:586-286-9644
Practice Address - Fax:586-286-9647
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-03
Last Update Date:2010-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301407063207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty