Provider Demographics
NPI:1639618267
Name:PHYSICAL THERAPY MANAGEMENT MI LLC
Entity Type:Organization
Organization Name:PHYSICAL THERAPY MANAGEMENT MI LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RAWAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SHKOUKANI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:586-202-6706
Mailing Address - Street 1:PO BOX 431361
Mailing Address - Street 2:
Mailing Address - City:PONTIAC
Mailing Address - State:MI
Mailing Address - Zip Code:48343-1361
Mailing Address - Country:US
Mailing Address - Phone:248-747-3497
Mailing Address - Fax:800-980-3329
Practice Address - Street 1:461 W HURON ST
Practice Address - Street 2:SUITE # G70
Practice Address - City:PONTIAC
Practice Address - State:MI
Practice Address - Zip Code:48341-1601
Practice Address - Country:US
Practice Address - Phone:248-747-3497
Practice Address - Fax:800-980-3329
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-15
Last Update Date:2017-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy