Provider Demographics
NPI:1972672418
Name:DEVINNEY CZARNECKI PHYSICAL THERAPY PC
Entity Type:Organization
Organization Name:DEVINNEY CZARNECKI PHYSICAL THERAPY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR, OWNER, P.T.
Authorized Official - Prefix:
Authorized Official - First Name:LOREN
Authorized Official - Middle Name:
Authorized Official - Last Name:DEVINNEY
Authorized Official - Suffix:
Authorized Official - Credentials:PT, OMPT
Authorized Official - Phone:248-851-6999
Mailing Address - Street 1:6020 W MAPLE RD
Mailing Address - Street 2:SUITE 500
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322-4409
Mailing Address - Country:US
Mailing Address - Phone:248-851-6999
Mailing Address - Fax:248-851-6898
Practice Address - Street 1:6020 W MAPLE RD
Practice Address - Street 2:SUITE 500
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48322-4409
Practice Address - Country:US
Practice Address - Phone:248-851-6999
Practice Address - Fax:248-851-6898
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-07
Last Update Date:2012-12-18
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
30619OtherBCBS FACILITY ID
236684Medicare ID - Type Unspecified