Provider Demographics
NPI:1497020978
Name:SUCCESS THERAPY SERVICES
Entity Type:Organization
Organization Name:SUCCESS THERAPY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MA
Authorized Official - Prefix:
Authorized Official - First Name:MAURICE
Authorized Official - Middle Name:K
Authorized Official - Last Name:WEBB GAMBRELL
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:313-556-4031
Mailing Address - Street 1:20055 SOUTHFIELD FWY
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48235-2278
Mailing Address - Country:US
Mailing Address - Phone:313-556-4031
Mailing Address - Fax:
Practice Address - Street 1:20055 SOUTHFIELD FWY
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48235-2278
Practice Address - Country:US
Practice Address - Phone:313-556-4031
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-15
Last Update Date:2014-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy