Provider Demographics
NPI:1396913844
Name:DEARBORN PHYSICAL THERAPY LTD.
Entity type:Organization
Organization Name:DEARBORN PHYSICAL THERAPY LTD.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:LAWRANCE
Authorized Official - Middle Name:W
Authorized Official - Last Name:MCAFEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-297-7000
Mailing Address - Street 1:26025 LAHSER RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48033-2606
Mailing Address - Country:US
Mailing Address - Phone:248-663-1906
Mailing Address - Fax:248-663-1903
Practice Address - Street 1:26025 LAHSER RD
Practice Address - Street 2:SUITE 100
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48033-2606
Practice Address - Country:US
Practice Address - Phone:248-663-1906
Practice Address - Fax:248-663-1903
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DEARBORN PHYSICAL THERAPY LTD.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-02-19
Last Update Date:2009-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4880370002Medicare NSC