Provider Demographics
NPI:1083096176
Name:PURE THERAPY CENTERS LLC
Entity Type:Organization
Organization Name:PURE THERAPY CENTERS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:HOURANI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-438-6053
Mailing Address - Street 1:10423 W WARREN AVE
Mailing Address - Street 2:STE 100
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48126-1660
Mailing Address - Country:US
Mailing Address - Phone:313-438-6053
Mailing Address - Fax:313-442-0790
Practice Address - Street 1:10423 W WARREN AVE
Practice Address - Street 2:STE 100
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126-1660
Practice Address - Country:US
Practice Address - Phone:313-438-6053
Practice Address - Fax:313-442-0790
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-24
Last Update Date:2015-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy