Provider Demographics
NPI:1790143824
Name:PREVENTATIVE THERAPY, LLC
Entity Type:Organization
Organization Name:PREVENTATIVE THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:AMAR
Authorized Official - Middle Name:N
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:313-914-7590
Mailing Address - Street 1:25507 ECORSE RD
Mailing Address - Street 2:STE D
Mailing Address - City:TAYLOR
Mailing Address - State:MI
Mailing Address - Zip Code:48180-1555
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:25507 ECORSE RD
Practice Address - Street 2:STE D
Practice Address - City:TAYLOR
Practice Address - State:MI
Practice Address - Zip Code:48180-1555
Practice Address - Country:US
Practice Address - Phone:313-914-7590
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-03
Last Update Date:2016-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy