Provider Demographics
NPI:1497268460
Name:MUNGER PHYSICAL THERAPY OF CLINTON TOWNSHIP, PLC
Entity Type:Organization
Organization Name:MUNGER PHYSICAL THERAPY OF CLINTON TOWNSHIP, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARKUS
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:MUNGER
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:810-385-7405
Mailing Address - Street 1:4351 24TH AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:FORT GRATIOT
Mailing Address - State:MI
Mailing Address - Zip Code:48059-4506
Mailing Address - Country:US
Mailing Address - Phone:810-385-7405
Mailing Address - Fax:
Practice Address - Street 1:4351 24TH AVE STE 1
Practice Address - Street 2:
Practice Address - City:FORT GRATIOT
Practice Address - State:MI
Practice Address - Zip Code:48059-4506
Practice Address - Country:US
Practice Address - Phone:810-385-7405
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MUNGER PHYSICAL THERAPY, PLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-11-13
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty