Provider Demographics
NPI:1346692621
Name:MOUND PHYSICAL THERAPY & REHAB INC
Entity Type:Organization
Organization Name:MOUND PHYSICAL THERAPY & REHAB INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NIKOLETA
Authorized Official - Middle Name:
Authorized Official - Last Name:LISI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:586-883-6038
Mailing Address - Street 1:39501 MOUND RD
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48310-2744
Mailing Address - Country:US
Mailing Address - Phone:586-883-6038
Mailing Address - Fax:586-883-6352
Practice Address - Street 1:39501 MOUND RD
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48310-2744
Practice Address - Country:US
Practice Address - Phone:586-883-6038
Practice Address - Fax:586-883-6352
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-11
Last Update Date:2016-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty