Provider Demographics
NPI:1124027966
Name:HAMTRAMCK ORTHOPEDIC PHYSICAL THERAPY, INC.
Entity Type:Organization
Organization Name:HAMTRAMCK ORTHOPEDIC PHYSICAL THERAPY, INC.
Other - Org Name:OPTIMAL REHAB & WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO / ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:BRANDEN
Authorized Official - Middle Name:
Authorized Official - Last Name:MCDOWELL
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:810-653-0100
Mailing Address - Street 1:9100 LAPEER RD
Mailing Address - Street 2:
Mailing Address - City:DAVISON
Mailing Address - State:MI
Mailing Address - Zip Code:48423-1746
Mailing Address - Country:US
Mailing Address - Phone:810-653-0100
Mailing Address - Fax:810-653-0133
Practice Address - Street 1:9100 LAPEER RD
Practice Address - Street 2:
Practice Address - City:DAVISON
Practice Address - State:MI
Practice Address - Zip Code:48423-1746
Practice Address - Country:US
Practice Address - Phone:810-653-0100
Practice Address - Fax:810-653-0133
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI650H257390OtherBCBSM - INDEPENDENT
MI30001OtherBCBSM
MI650H257390OtherBCBSM - INDEPENDENT