Provider Demographics
NPI:1588609283
Name:ADVANCED INTEGRATED MANUAL PHYSICAL THERAPY PLLC
Entity Type:Organization
Organization Name:ADVANCED INTEGRATED MANUAL PHYSICAL THERAPY PLLC
Other - Org Name:A.I.M. PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MS
Authorized Official - First Name:ADRIA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:PODLEWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:586-977-6019
Mailing Address - Street 1:33188 MORRISON CT
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48312-6544
Mailing Address - Country:US
Mailing Address - Phone:586-977-6019
Mailing Address - Fax:
Practice Address - Street 1:29500 RYAN RD
Practice Address - Street 2:SUITE A & B
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48092-2213
Practice Address - Country:US
Practice Address - Phone:586-977-6019
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-17
Last Update Date:2007-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501005814225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0P37600Medicare PIN
MIP37600001Medicare UPIN