Provider Demographics
NPI:1639292014
Name:PHYSICAL THERAPY SERVICES, INC.
Entity Type:Organization
Organization Name:PHYSICAL THERAPY SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:PANKAJ
Authorized Official - Middle Name:
Authorized Official - Last Name:MAMTORA
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:248-565-4000
Mailing Address - Street 1:26400 W 12 MILE RD STE 25
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48034-1774
Mailing Address - Country:US
Mailing Address - Phone:248-565-4000
Mailing Address - Fax:248-565-4020
Practice Address - Street 1:26400 W 12 MILE RD STE 25
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-1774
Practice Address - Country:US
Practice Address - Phone:248-565-4000
Practice Address - Fax:248-565-4020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-09
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
23-6832Medicare PIN