Provider Demographics
NPI:1558740423
Name:THERACURE PHYSICAL THERAPY
Entity Type:Organization
Organization Name:THERACURE PHYSICAL THERAPY
Other - Org Name:THERACURE PHYSICAL THERAPY LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ADIB
Authorized Official - Middle Name:
Authorized Official - Last Name:SOBH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-438-0438
Mailing Address - Street 1:14711 FORD RD
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48126-3040
Mailing Address - Country:US
Mailing Address - Phone:313-438-0438
Mailing Address - Fax:313-438-0439
Practice Address - Street 1:14711 FORD RD
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126-3040
Practice Address - Country:US
Practice Address - Phone:313-438-0438
Practice Address - Fax:313-438-0439
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-26
Last Update Date:2015-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501006578251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services