Provider Demographics
NPI:1174023246
Name:LEVEL 1 HEALTH SYSTEMS OF MICHIGAN
Entity Type:Organization
Organization Name:LEVEL 1 HEALTH SYSTEMS OF MICHIGAN
Other - Org Name:LEVEL 1 PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:SABAH
Authorized Official - Middle Name:
Authorized Official - Last Name:DEHKO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-882-0764
Mailing Address - Street 1:26321 WOODWARD AVE
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON WOODS
Mailing Address - State:MI
Mailing Address - Zip Code:48070-1331
Mailing Address - Country:US
Mailing Address - Phone:248-544-7500
Mailing Address - Fax:248-544-7555
Practice Address - Street 1:26321 WOODWARD AVE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON WOODS
Practice Address - State:MI
Practice Address - Zip Code:48070-1331
Practice Address - Country:US
Practice Address - Phone:248-544-7500
Practice Address - Fax:248-544-7555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-15
Last Update Date:2018-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501015177225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty