Provider Demographics
NPI:1689336646
Name:MAGIC TOUCH THERAPY LLC
Entity Type:Organization
Organization Name:MAGIC TOUCH THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HANI
Authorized Official - Middle Name:
Authorized Official - Last Name:HAIDER-AHMAD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:424-232-3794
Mailing Address - Street 1:5871 TELEGRAPH RD
Mailing Address - Street 2:
Mailing Address - City:TAYLOR
Mailing Address - State:MI
Mailing Address - Zip Code:48180-1214
Mailing Address - Country:US
Mailing Address - Phone:424-232-3794
Mailing Address - Fax:
Practice Address - Street 1:5871 TELEGRAPH RD
Practice Address - Street 2:
Practice Address - City:TAYLOR
Practice Address - State:MI
Practice Address - Zip Code:48180-1214
Practice Address - Country:US
Practice Address - Phone:424-232-3794
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-07
Last Update Date:2021-10-07
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
MIPENDINGMedicaid