Provider Demographics
NPI:1881193514
Name:DETROIT HEALING HANDS PHYSICAL THERAPY CENTER, LLC
Entity Type:Organization
Organization Name:DETROIT HEALING HANDS PHYSICAL THERAPY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:JACKOSN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-520-6714
Mailing Address - Street 1:1866 DORCHESTER DR N APT 204
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48084-8317
Mailing Address - Country:US
Mailing Address - Phone:313-520-6714
Mailing Address - Fax:
Practice Address - Street 1:19522 W MCNICHOLS RD STE E
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48219-4090
Practice Address - Country:US
Practice Address - Phone:313-727-1330
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-08
Last Update Date:2018-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy