Provider Demographics
NPI:1922532571
Name:PEDIATRIC MOTORWERKS PHYSICAL THERAPY, LLC
Entity Type:Organization
Organization Name:PEDIATRIC MOTORWERKS PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLER-WILKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:231-855-2809
Mailing Address - Street 1:50920 VAN DYKE AVE
Mailing Address - Street 2:
Mailing Address - City:SHELBY TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48317-1367
Mailing Address - Country:US
Mailing Address - Phone:586-330-0872
Mailing Address - Fax:866-630-0604
Practice Address - Street 1:50920 VAN DYKE AVE
Practice Address - Street 2:
Practice Address - City:SHELBY TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48317-1367
Practice Address - Country:US
Practice Address - Phone:586-330-0872
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-19
Last Update Date:2022-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501017752261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy