Provider Demographics
NPI:1679657621
Name:ORION PHYSICAL THERAPY, PLLC
Entity Type:Organization
Organization Name:ORION PHYSICAL THERAPY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRETT
Authorized Official - Middle Name:
Authorized Official - Last Name:DEBO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-814-8060
Mailing Address - Street 1:1210 S LAPEER RD
Mailing Address - Street 2:
Mailing Address - City:LAKE ORION
Mailing Address - State:MI
Mailing Address - Zip Code:48360-1433
Mailing Address - Country:US
Mailing Address - Phone:248-814-8060
Mailing Address - Fax:248-814-8070
Practice Address - Street 1:1210 S LAPEER RD
Practice Address - Street 2:
Practice Address - City:LAKE ORION
Practice Address - State:MI
Practice Address - Zip Code:48360-1433
Practice Address - Country:US
Practice Address - Phone:248-814-8060
Practice Address - Fax:248-814-8070
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2008-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0007628683OtherAETNA ID NUMBER
MIN73270002OtherHAP ID NUMBER
MI0N73270Medicare PIN