Provider Demographics
NPI:1871660340
Name:ABILITY PHYSICAL THERAPY
Entity Type:Organization
Organization Name:ABILITY PHYSICAL THERAPY
Other - Org Name:ABILITY WORKS OUTPATIENT SERVICES
Other - Org Type:Other Name
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:C
Authorized Official - Last Name:NALAZEK
Authorized Official - Suffix:
Authorized Official - Credentials:OMT, PT, CWT
Authorized Official - Phone:586-790-2326
Mailing Address - Street 1:18791 15 MILE RD
Mailing Address - Street 2:
Mailing Address - City:CLINTON TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48035-2503
Mailing Address - Country:US
Mailing Address - Phone:586-790-2326
Mailing Address - Fax:586-790-2476
Practice Address - Street 1:18791 15 MILE RD
Practice Address - Street 2:
Practice Address - City:CLINTON TWP
Practice Address - State:MI
Practice Address - Zip Code:48035-2503
Practice Address - Country:US
Practice Address - Phone:586-790-2326
Practice Address - Fax:586-790-2476
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-29
Last Update Date:2013-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501004297225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4914916Medicaid
MIP39720001OtherMEDICARE-INDIVIDUAL
MIP39720001OtherMEDICARE-INDIVIDUAL