Provider Demographics
NPI:1760861926
Name:INNOVATIVE PHYSICAL THERAPY INC
Entity Type:Organization
Organization Name:INNOVATIVE PHYSICAL THERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:VOITEK
Authorized Official - Middle Name:
Authorized Official - Last Name:MALINOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:RPT
Authorized Official - Phone:248-515-7564
Mailing Address - Street 1:361 W SQUARE LAKE RD
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48098-2969
Mailing Address - Country:US
Mailing Address - Phone:248-515-7564
Mailing Address - Fax:
Practice Address - Street 1:21618 E 9 MILE RD STE 2
Practice Address - Street 2:
Practice Address - City:SAINT CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48080-1864
Practice Address - Country:US
Practice Address - Phone:248-515-7564
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-21
Last Update Date:2015-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501006064225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIPENDINGMedicare PIN