Provider Demographics
NPI:1043617467
Name:LOCAL PHYSICAL THERAPY CENTER, PLLC
Entity Type:Organization
Organization Name:LOCAL PHYSICAL THERAPY CENTER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EWA
Authorized Official - Middle Name:MAGDALENA
Authorized Official - Last Name:PLUSZCZYK
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:248-770-2428
Mailing Address - Street 1:7650 DIXIE HWY
Mailing Address - Street 2:130
Mailing Address - City:CLARKSTON
Mailing Address - State:MI
Mailing Address - Zip Code:48346-2078
Mailing Address - Country:US
Mailing Address - Phone:248-770-2428
Mailing Address - Fax:
Practice Address - Street 1:7650 DIXIE HWY
Practice Address - Street 2:130
Practice Address - City:CLARKSTON
Practice Address - State:MI
Practice Address - Zip Code:48346-2078
Practice Address - Country:US
Practice Address - Phone:248-770-2428
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-01
Last Update Date:2014-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501007830261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy