Provider Demographics
NPI:1275747941
Name:PHYSICAL THERAPY TEAM, P.C.
Entity Type:Organization
Organization Name:PHYSICAL THERAPY TEAM, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:NATHANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-618-1041
Mailing Address - Street 1:28871 FARMINGTON RD
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334-2613
Mailing Address - Country:US
Mailing Address - Phone:313-618-1041
Mailing Address - Fax:
Practice Address - Street 1:24060 W 10 MILE RD
Practice Address - Street 2:STE 102
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48033-3006
Practice Address - Country:US
Practice Address - Phone:248-746-1132
Practice Address - Fax:248-746-1133
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2013-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI236816Medicare Oscar/Certification