Provider Demographics
NPI:1689192221
Name:ARCTURUS PLLC
Entity Type:Organization
Organization Name:ARCTURUS PLLC
Other - Org Name:LIBRA PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:JOLANTA
Authorized Official - Last Name:ROSZCZENKO
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:248-933-2579
Mailing Address - Street 1:41895 POCATELLO DR
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48187
Mailing Address - Country:US
Mailing Address - Phone:248-933-2579
Mailing Address - Fax:
Practice Address - Street 1:8526 N CANTON CENTER RD
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48187-1310
Practice Address - Country:US
Practice Address - Phone:248-933-2579
Practice Address - Fax:734-273-9361
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-04
Last Update Date:2022-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501012986225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty