Provider Demographics
NPI:1205865961
Name:OMPT SPECIALISTS, INC.
Entity Type:Organization
Organization Name:OMPT SPECIALISTS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:N
Authorized Official - Last Name:FAHMY
Authorized Official - Suffix:
Authorized Official - Credentials:DPT, OMPT
Authorized Official - Phone:248-353-1234
Mailing Address - Street 1:1080 KIRTS BLVD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48084-4841
Mailing Address - Country:US
Mailing Address - Phone:248-353-1234
Mailing Address - Fax:248-743-1237
Practice Address - Street 1:29255 NORTHWESTERN HWY
Practice Address - Street 2:SUITE 300
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034
Practice Address - Country:US
Practice Address - Phone:248-353-1234
Practice Address - Fax:248-353-1211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-02
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0P33570Medicare PIN