Provider Demographics
NPI:1235329921
Name:PREMIER CARE PHYSICAL THERAPY, P.C.
Entity Type:Organization
Organization Name:PREMIER CARE PHYSICAL THERAPY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROSARIO
Authorized Official - Middle Name:GUMBAN
Authorized Official - Last Name:AFANTE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:485-266-6002
Mailing Address - Street 1:33200 DEQUINDRE RD STE 101
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48310-5967
Mailing Address - Country:US
Mailing Address - Phone:248-526-6600
Mailing Address - Fax:248-526-6699
Practice Address - Street 1:33200 DEQUINDRE RD STE 101
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48310-5967
Practice Address - Country:US
Practice Address - Phone:248-526-6600
Practice Address - Fax:248-526-6699
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-28
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0P47770Medicare PIN