Provider Demographics
NPI:1225448509
Name:VICTORY PHYSICAL THERAPY
Entity Type:Organization
Organization Name:VICTORY PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GEOFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:SAGALA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-595-5668
Mailing Address - Street 1:23300 GREENFIELD RD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:OAK PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48237-5237
Mailing Address - Country:US
Mailing Address - Phone:248-268-3180
Mailing Address - Fax:248-268-3182
Practice Address - Street 1:23300 GREENFIELD RD
Practice Address - Street 2:SUITE 105
Practice Address - City:OAK PARK
Practice Address - State:MI
Practice Address - Zip Code:48237-5237
Practice Address - Country:US
Practice Address - Phone:248-268-3180
Practice Address - Fax:248-268-3182
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-07
Last Update Date:2014-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIE4330N261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy