Provider Demographics
NPI:1649205121
Name:METROPOLITAN PHYSICAL THERAPY AGENCY, INC.
Entity Type:Organization
Organization Name:METROPOLITAN PHYSICAL THERAPY AGENCY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:HINA
Authorized Official - Middle Name:T
Authorized Official - Last Name:QAZI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-512-8009
Mailing Address - Street 1:13636 DIX TOLEDO RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:SOUTHGATE
Mailing Address - State:MI
Mailing Address - Zip Code:48195-2432
Mailing Address - Country:US
Mailing Address - Phone:734-283-2262
Mailing Address - Fax:248-808-6268
Practice Address - Street 1:13636 DIX TOLEDO RD
Practice Address - Street 2:SUITE B
Practice Address - City:SOUTHGATE
Practice Address - State:MI
Practice Address - Zip Code:48195-2432
Practice Address - Country:US
Practice Address - Phone:734-283-2262
Practice Address - Fax:248-808-6268
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-12
Last Update Date:2015-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI261QH0100X
MI1482188261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI30710OtherBCN MI
MI30710OtherBCBSMI
MI236743Medicare Oscar/Certification