Provider Demographics
NPI:1245747401
Name:EVIDENCE IN MANUAL PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:EVIDENCE IN MANUAL PHYSICAL THERAPY LLC
Other - Org Name:EIM PT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ISHAK
Authorized Official - Middle Name:ADEL
Authorized Official - Last Name:YANNI
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:248-688-5601
Mailing Address - Street 1:6634 CHATHAM CIR
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48306-4383
Mailing Address - Country:US
Mailing Address - Phone:248-688-5601
Mailing Address - Fax:
Practice Address - Street 1:39070 VAN DYKE AVE
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48313-4613
Practice Address - Country:US
Practice Address - Phone:248-688-5601
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-09
Last Update Date:2021-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501014924225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty