Provider Demographics
NPI:1851696900
Name:MENDELSON KORNBLUM SOUTHFIELD PHYSICAL THERAPY PLLC
Entity Type:Organization
Organization Name:MENDELSON KORNBLUM SOUTHFIELD PHYSICAL THERAPY PLLC
Other - Org Name:MKS PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:MENDELSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:734-542-9770
Mailing Address - Street 1:20475 W 10 MILE RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-6105
Mailing Address - Country:US
Mailing Address - Phone:734-542-9770
Mailing Address - Fax:
Practice Address - Street 1:20475 W 10 MILE RD
Practice Address - Street 2:SUITE 101
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-6105
Practice Address - Country:US
Practice Address - Phone:734-542-9770
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-21
Last Update Date:2011-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty