Provider Demographics
NPI:1407359094
Name:PRIME ONE PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:PRIME ONE PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MOHAMAD
Authorized Official - Middle Name:
Authorized Official - Last Name:BAZZI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-960-6767
Mailing Address - Street 1:1441 E MAPLE RD STE 102
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48083-4025
Mailing Address - Country:US
Mailing Address - Phone:313-960-6767
Mailing Address - Fax:313-357-3670
Practice Address - Street 1:1441 E MAPLE RD STE 102
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48083-4025
Practice Address - Country:US
Practice Address - Phone:313-960-6767
Practice Address - Fax:313-357-3670
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-09
Last Update Date:2018-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy