Provider Demographics
NPI:1609839869
Name:HOLISTIC PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:HOLISTIC PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIEF THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:LAUER
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:734-243-2089
Mailing Address - Street 1:149 LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:MI
Mailing Address - Zip Code:48162-2606
Mailing Address - Country:US
Mailing Address - Phone:734-243-2089
Mailing Address - Fax:734-241-2275
Practice Address - Street 1:149 LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:MI
Practice Address - Zip Code:48162-2606
Practice Address - Country:US
Practice Address - Phone:734-243-2089
Practice Address - Fax:734-241-2275
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-10
Last Update Date:2022-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI550100-3481225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty