Provider Demographics
NPI:1417002650
Name:P.T. PLUS THERAPEUTIC RESOURCES, INC.
Entity Type:Organization
Organization Name:P.T. PLUS THERAPEUTIC RESOURCES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHARMA
Authorized Official - Suffix:
Authorized Official - Credentials:COTA
Authorized Official - Phone:734-285-6789
Mailing Address - Street 1:966 FORD AVE
Mailing Address - Street 2:
Mailing Address - City:WYANDOTTE
Mailing Address - State:MI
Mailing Address - Zip Code:48192-3851
Mailing Address - Country:US
Mailing Address - Phone:734-285-6789
Mailing Address - Fax:734-285-6778
Practice Address - Street 1:966 FORD AVE
Practice Address - Street 2:
Practice Address - City:WYANDOTTE
Practice Address - State:MI
Practice Address - Zip Code:48192-3851
Practice Address - Country:US
Practice Address - Phone:734-285-6789
Practice Address - Fax:734-285-6778
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4226098Medicaid
MI236783Medicare ID - Type Unspecified