Provider Demographics
NPI:1346798170
Name:THERAMEDIC REHAB AND PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:THERAMEDIC REHAB AND PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:PANKAJ
Authorized Official - Middle Name:
Authorized Official - Last Name:MAMTORA
Authorized Official - Suffix:
Authorized Official - Credentials:PHYSICAL THERAPIST
Authorized Official - Phone:248-565-4000
Mailing Address - Street 1:12603 SOUTHWEST FWY STE 101
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:TX
Mailing Address - Zip Code:77477-3841
Mailing Address - Country:US
Mailing Address - Phone:833-733-6978
Mailing Address - Fax:833-733-3778
Practice Address - Street 1:12603 SOUTHWEST FWY STE 101
Practice Address - Street 2:
Practice Address - City:STAFFORD
Practice Address - State:TX
Practice Address - Zip Code:77477-3841
Practice Address - Country:US
Practice Address - Phone:833-733-6978
Practice Address - Fax:833-733-3778
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-21
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy