Provider Demographics
NPI:1487631966
Name:PHYSICAL THERAPY CENTER
Entity Type:Organization
Organization Name:PHYSICAL THERAPY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RAKESH
Authorized Official - Middle Name:
Authorized Official - Last Name:SACHDEVA
Authorized Official - Suffix:
Authorized Official - Credentials:RPT
Authorized Official - Phone:248-651-4573
Mailing Address - Street 1:586 S ROCHESTER RD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48307-2736
Mailing Address - Country:US
Mailing Address - Phone:248-651-4573
Mailing Address - Fax:248-651-5394
Practice Address - Street 1:586 S ROCHESTER RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48307-2736
Practice Address - Country:US
Practice Address - Phone:248-651-4573
Practice Address - Fax:248-651-5394
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-27
Last Update Date:2009-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501005281261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI451296510Medicaid
MI236649Medicare ID - Type UnspecifiedPROVIDER NUMBER