Provider Demographics
NPI:1629582432
Name:PULSE PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:PULSE PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SAMAR
Authorized Official - Middle Name:
Authorized Official - Last Name:GHOSN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-903-5151
Mailing Address - Street 1:15400 MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48126-3491
Mailing Address - Country:US
Mailing Address - Phone:313-903-5151
Mailing Address - Fax:
Practice Address - Street 1:15400 MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126-3491
Practice Address - Country:US
Practice Address - Phone:313-903-5151
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-01
Last Update Date:2017-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIF2654C261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy