Provider Demographics
NPI:1184076382
Name:VISITING THERAPIST INC
Entity type:Organization
Organization Name:VISITING THERAPIST INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ALI
Authorized Official - Middle Name:
Authorized Official - Last Name:AL-KHAFAJI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-298-0221
Mailing Address - Street 1:28459 DEQUINDRE RD
Mailing Address - Street 2:STE D
Mailing Address - City:MADISON HTS
Mailing Address - State:MI
Mailing Address - Zip Code:48071-3080
Mailing Address - Country:US
Mailing Address - Phone:248-298-0221
Mailing Address - Fax:248-298-0224
Practice Address - Street 1:28459 DEQUINDRE RD
Practice Address - Street 2:STE D
Practice Address - City:MADISON HTS
Practice Address - State:MI
Practice Address - Zip Code:48071-3080
Practice Address - Country:US
Practice Address - Phone:248-298-0221
Practice Address - Fax:248-298-0224
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-12
Last Update Date:2016-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1245286384Medicare NSC