Provider Demographics
NPI:1215364880
Name:ADEQUATE PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:ADEQUATE PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HAIDAR
Authorized Official - Middle Name:
Authorized Official - Last Name:HAZIME
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-646-5034
Mailing Address - Street 1:2355 FORT ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48146-2464
Mailing Address - Country:US
Mailing Address - Phone:313-724-7670
Mailing Address - Fax:
Practice Address - Street 1:2355 FORT ST
Practice Address - Street 2:
Practice Address - City:LINCOLN PARK
Practice Address - State:MI
Practice Address - Zip Code:48146-2464
Practice Address - Country:US
Practice Address - Phone:313-724-7670
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-27
Last Update Date:2013-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy