Provider Demographics
NPI:1083035067
Name:MICHIGAN TRI-COUNTY PHYSICAL THERAPY PLLC
Entity Type:Organization
Organization Name:MICHIGAN TRI-COUNTY PHYSICAL THERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:LOLITA
Authorized Official - Middle Name:M
Authorized Official - Last Name:MALISKEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:586-530-0904
Mailing Address - Street 1:28475 VAN DYKE AVE
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48093-7132
Mailing Address - Country:US
Mailing Address - Phone:586-806-4542
Mailing Address - Fax:586-806-4546
Practice Address - Street 1:28475 VAN DYKE AVE
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48093-7132
Practice Address - Country:US
Practice Address - Phone:586-806-4542
Practice Address - Fax:586-806-4546
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-18
Last Update Date:2013-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501009638261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy