Provider Demographics
NPI:1952440497
Name:SPARTAN PHYSICAL THERAPY ,INC.
Entity Type:Organization
Organization Name:SPARTAN PHYSICAL THERAPY ,INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:SULTAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MAHMOOD
Authorized Official - Suffix:
Authorized Official - Credentials:RPT
Authorized Official - Phone:248-542-7440
Mailing Address - Street 1:56187 NICKELBY S
Mailing Address - Street 2:
Mailing Address - City:SHELBY TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48316-5502
Mailing Address - Country:US
Mailing Address - Phone:248-542-7440
Mailing Address - Fax:248-545-4327
Practice Address - Street 1:27031 DEQUINDRE RD
Practice Address - Street 2:
Practice Address - City:MADISON HTS
Practice Address - State:MI
Practice Address - Zip Code:48071-3401
Practice Address - Country:US
Practice Address - Phone:248-542-7440
Practice Address - Fax:248-545-4327
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-05
Last Update Date:2012-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501004932225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0F35778OtherBCBS PROVIDER NUMBER
MIN99400001Medicare ID - Type UnspecifiedPROVIDER NUMBER