Provider Demographics
NPI:1245228113
Name:PHYSICAL THERAPY PROFESSIONALS PC
Entity Type:Organization
Organization Name:PHYSICAL THERAPY PROFESSIONALS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DIANN
Authorized Official - Middle Name:E
Authorized Official - Last Name:INCH
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:586-598-0050
Mailing Address - Street 1:50475 GRATIOT AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48051-3128
Mailing Address - Country:US
Mailing Address - Phone:586-598-0050
Mailing Address - Fax:586-598-1804
Practice Address - Street 1:50475 GRATIOT AVE
Practice Address - Street 2:SUITE B
Practice Address - City:CHESTERFIELD
Practice Address - State:MI
Practice Address - Zip Code:48051-3128
Practice Address - Country:US
Practice Address - Phone:586-598-0050
Practice Address - Fax:586-598-1804
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-13
Last Update Date:2020-08-22
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
MI236576Medicare ID - Type Unspecified