Provider Demographics
NPI:1346612579
Name:TLC GROUP LLC
Entity Type:Organization
Organization Name:TLC GROUP LLC
Other - Org Name:CHRONIC PAIN SOLUTIONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TIZIANO
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:MAROVINO
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:734-879-1138
Mailing Address - Street 1:1947 WHITTAKER RD
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-9701
Mailing Address - Country:US
Mailing Address - Phone:734-879-1138
Mailing Address - Fax:734-879-1156
Practice Address - Street 1:1947 WHITTAKER RD
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-9432
Practice Address - Country:US
Practice Address - Phone:734-879-1138
Practice Address - Fax:734-879-1156
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI55010045802251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1205952546OtherTYPE 1 NPI
MIM16211020Medicare PIN
MIP98693Medicare UPIN