Provider Demographics
NPI:1346893682
Name:RESTORATIVE PHYSICAL THERAPY SERVICES, LLC
Entity Type:Organization
Organization Name:RESTORATIVE PHYSICAL THERAPY SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JAWAD
Authorized Official - Middle Name:ALAM
Authorized Official - Last Name:KARAM
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:248-296-4053
Mailing Address - Street 1:17200 E 10 MILE RD STE 165
Mailing Address - Street 2:
Mailing Address - City:EASTPOINTE
Mailing Address - State:MI
Mailing Address - Zip Code:48021-3349
Mailing Address - Country:US
Mailing Address - Phone:586-298-6909
Mailing Address - Fax:586-298-6914
Practice Address - Street 1:17200 E 10 MILE RD STE 165
Practice Address - Street 2:
Practice Address - City:EASTPOINTE
Practice Address - State:MI
Practice Address - Zip Code:48021-3349
Practice Address - Country:US
Practice Address - Phone:586-298-6909
Practice Address - Fax:586-298-6914
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-16
Last Update Date:2019-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1225571417OtherNATIONAL PROVIDER IDENTIFICATION NUMBER
MI1225571417Medicaid