Provider Demographics
NPI:1174832083
Name:PRO-MOTION PHYSICAL THERAPY, PLLC
Entity Type:Organization
Organization Name:PRO-MOTION PHYSICAL THERAPY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:BAYLERIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-514-3112
Mailing Address - Street 1:6412 BLACK WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:MI
Mailing Address - Zip Code:48116-6724
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:205 W GRAND RIVER AVE
Practice Address - Street 2:STE 201
Practice Address - City:BRIGHTON
Practice Address - State:MI
Practice Address - Zip Code:48116-1647
Practice Address - Country:US
Practice Address - Phone:248-514-3112
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-27
Last Update Date:2010-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty