Provider Demographics
NPI:1912044058
Name:PHYSIOTHERAPY ASSOCIATES
Entity Type:Organization
Organization Name:PHYSIOTHERAPY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KRYSTI
Authorized Official - Middle Name:
Authorized Official - Last Name:ZIZZO
Authorized Official - Suffix:
Authorized Official - Credentials:MS PT
Authorized Official - Phone:734-433-9703
Mailing Address - Street 1:44555 JOY RD
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48187-1771
Mailing Address - Country:US
Mailing Address - Phone:734-451-9878
Mailing Address - Fax:
Practice Address - Street 1:44555 JOY RD
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48187-1771
Practice Address - Country:US
Practice Address - Phone:734-451-9878
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI236629Medicare ID - Type Unspecified