Provider Demographics
NPI:1255667556
Name:ABYSSINIA LOVE KNOT PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:ABYSSINIA LOVE KNOT PHYSICAL THERAPY LLC
Other - Org Name:ASSURANCE APPROPRIATIONS CASE MANAGEMENT SYSTEMS, L.L.C.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR APPROPRIATIONS CASE M
Authorized Official - Prefix:MS
Authorized Official - First Name:SHIRLEY
Authorized Official - Middle Name:A
Authorized Official - Last Name:DOUGLAS
Authorized Official - Suffix:
Authorized Official - Credentials:MAPM, DD
Authorized Official - Phone:313-646-6929
Mailing Address - Street 1:21700 GREENFIELD RD
Mailing Address - Street 2:SUITE 215
Mailing Address - City:OAK PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48237-2581
Mailing Address - Country:US
Mailing Address - Phone:248-968-6899
Mailing Address - Fax:248-968-4443
Practice Address - Street 1:15340 SOUTHFIELD FREEWAY
Practice Address - Street 2:SUITE 1-A
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48223
Practice Address - Country:US
Practice Address - Phone:313-646-6929
Practice Address - Fax:313-646-6929
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-22
Last Update Date:2019-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty