Provider Demographics
NPI:1649742396
Name:WARREN TEAM CARE PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:WARREN TEAM CARE PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:
Authorized Official - Last Name:MAHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-374-2446
Mailing Address - Street 1:7560 E 9 MILE RD
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48091-2643
Mailing Address - Country:US
Mailing Address - Phone:586-619-7922
Mailing Address - Fax:586-619-7924
Practice Address - Street 1:7560 E 9 MILE RD
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48091-2643
Practice Address - Country:US
Practice Address - Phone:586-619-7922
Practice Address - Fax:586-619-7924
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-19
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy