Provider Demographics
NPI:1245624410
Name:CARTER SPINAL ORTHOPEDIC AND SPORTS REHAB
Entity type:Organization
Organization Name:CARTER SPINAL ORTHOPEDIC AND SPORTS REHAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DENEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:CARTER
Authorized Official - Suffix:
Authorized Official - Credentials:DPT OMPT CSCS
Authorized Official - Phone:313-341-5534
Mailing Address - Street 1:20051 RENFREW RD
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48221-1391
Mailing Address - Country:US
Mailing Address - Phone:313-341-5534
Mailing Address - Fax:
Practice Address - Street 1:27200 LAHSER RD
Practice Address - Street 2:SUITE 100
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-2137
Practice Address - Country:US
Practice Address - Phone:313-341-5534
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-25
Last Update Date:2015-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501004885261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy