Provider Demographics
NPI:1073011573
Name:UNITED WELLNESS PHYSICAL THERAPY, LLC
Entity Type:Organization
Organization Name:UNITED WELLNESS PHYSICAL THERAPY, LLC
Other - Org Name:UNITED WELLNESS PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MISS
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:SANMIQUEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:947-282-6614
Mailing Address - Street 1:20755 GREENFIELD RD STE 800
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-5410
Mailing Address - Country:US
Mailing Address - Phone:947-282-6614
Mailing Address - Fax:
Practice Address - Street 1:20755 GREENFIELD RD STE 800
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-5410
Practice Address - Country:US
Practice Address - Phone:313-350-0025
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-30
Last Update Date:2020-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical TherapyGroup - Single Specialty