Provider Demographics
NPI:1598520686
Name:MICHIGAN PHYSICAL THERAPY SERVICES LLC
Entity Type:Organization
Organization Name:MICHIGAN PHYSICAL THERAPY SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:IRAM
Authorized Official - Middle Name:Q
Authorized Official - Last Name:TARIQ
Authorized Official - Suffix:
Authorized Official - Credentials:OFFICE MANAGER
Authorized Official - Phone:248-482-3181
Mailing Address - Street 1:26211 CENTRAL PARK BLVD
Mailing Address - Street 2:STE 116
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48076-4107
Mailing Address - Country:US
Mailing Address - Phone:248-482-3181
Mailing Address - Fax:
Practice Address - Street 1:26211 CENTRAL PARK BLVD
Practice Address - Street 2:STE 116
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48076-4107
Practice Address - Country:US
Practice Address - Phone:248-482-3181
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-16
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy