Provider Demographics
NPI:1609152339
Name:NEW LIFE PHYSICAL THERAPY SERVICES LLC
Entity Type:Organization
Organization Name:NEW LIFE PHYSICAL THERAPY SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:NIRAV
Authorized Official - Middle Name:ANILKUMAR
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:RPT
Authorized Official - Phone:586-782-7061
Mailing Address - Street 1:25529 VAN DYKE AVE
Mailing Address - Street 2:SUITE A-1
Mailing Address - City:CENTER LINE
Mailing Address - State:MI
Mailing Address - Zip Code:48015-1848
Mailing Address - Country:US
Mailing Address - Phone:586-782-7061
Mailing Address - Fax:
Practice Address - Street 1:25529 VAN DYKE AVE
Practice Address - Street 2:SUITE A-1
Practice Address - City:CENTER LINE
Practice Address - State:MI
Practice Address - Zip Code:48015-1848
Practice Address - Country:US
Practice Address - Phone:586-782-7061
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-26
Last Update Date:2011-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501012206225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty