Provider Demographics
NPI:1326650011
Name:PHYSICAL THERAPY CENTER FOR SPORTS AND PERFORMING ARTS, PLLC
Entity Type:Organization
Organization Name:PHYSICAL THERAPY CENTER FOR SPORTS AND PERFORMING ARTS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, PHYSICAL THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEXANDRA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:PATTERSON TICHY
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:313-550-1592
Mailing Address - Street 1:36 DEVONSHIRE RD
Mailing Address - Street 2:
Mailing Address - City:PLEASANT RIDGE
Mailing Address - State:MI
Mailing Address - Zip Code:48069-1211
Mailing Address - Country:US
Mailing Address - Phone:313-550-1592
Mailing Address - Fax:
Practice Address - Street 1:30475 STEPHENSON HWY
Practice Address - Street 2:
Practice Address - City:MADISON HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48071-1615
Practice Address - Country:US
Practice Address - Phone:313-550-1592
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-23
Last Update Date:2020-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy