Provider Demographics
NPI:1205111465
Name:THERAPY UNLIMITED, LLC
Entity type:Organization
Organization Name:THERAPY UNLIMITED, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KELLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-952-4340
Mailing Address - Street 1:44125 W TWELVE MILE ROAD
Mailing Address - Street 2:E-123, BOX D7
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48377-1980
Mailing Address - Country:US
Mailing Address - Phone:248-952-4340
Mailing Address - Fax:248-465-6059
Practice Address - Street 1:44125 W TWELVE MILE ROAD
Practice Address - Street 2:E-123, BOX D7
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48377-1980
Practice Address - Country:US
Practice Address - Phone:248-952-4340
Practice Address - Fax:248-465-6059
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-19
Last Update Date:2019-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201009157261QX0100X
MI5501009589261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0H75004OtherBCBS
MI0H75004OtherBCBS