Provider Demographics
NPI:1104363647
Name:TROY PHYSICAL THERAPY SERVICES LLC
Entity Type:Organization
Organization Name:TROY PHYSICAL THERAPY SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MURTADHA
Authorized Official - Middle Name:
Authorized Official - Last Name:SUDANI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-817-5870
Mailing Address - Street 1:525 E BIG BEAVER RD
Mailing Address - Street 2:SUITE 305
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48083-1364
Mailing Address - Country:US
Mailing Address - Phone:248-817-5870
Mailing Address - Fax:248-817-5729
Practice Address - Street 1:525 E BIG BEAVER RD
Practice Address - Street 2:SUITE 305
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48083-1364
Practice Address - Country:US
Practice Address - Phone:248-817-5870
Practice Address - Fax:248-817-5729
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-23
Last Update Date:2017-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIPENDINGMedicare PIN