Provider Demographics
NPI:1922469071
Name:PRIMROSE PHYSICAL & AQUATIC THERAPY
Entity Type:Organization
Organization Name:PRIMROSE PHYSICAL & AQUATIC THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:BUTLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-885-9195
Mailing Address - Street 1:22463 NORFOLK CT
Mailing Address - Street 2:
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48374-3975
Mailing Address - Country:US
Mailing Address - Phone:248-513-6131
Mailing Address - Fax:248-719-7711
Practice Address - Street 1:22463 NORFOLK CT
Practice Address - Street 2:
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48374-3975
Practice Address - Country:US
Practice Address - Phone:248-513-6131
Practice Address - Fax:248-719-7711
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-17
Last Update Date:2016-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty