Provider Demographics
NPI:1518575018
Name:CITIZEN PHYSICAL THERAPY PLC
Entity Type:Organization
Organization Name:CITIZEN PHYSICAL THERAPY PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPY
Authorized Official - Prefix:
Authorized Official - First Name:FAZAL
Authorized Official - Middle Name:
Authorized Official - Last Name:KHALIQ
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:248-730-2312
Mailing Address - Street 1:265 MAIN ST STE B
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48111-3284
Mailing Address - Country:US
Mailing Address - Phone:248-730-2312
Mailing Address - Fax:
Practice Address - Street 1:265 MAIN ST STE B
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:MI
Practice Address - Zip Code:48111-3284
Practice Address - Country:US
Practice Address - Phone:248-730-2312
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-21
Last Update Date:2020-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIPENDINGMedicaid