Provider Demographics
NPI:1669605705
Name:QUANTUM PHYSICAL THERAPY - PITTSFIELD
Entity type:Organization
Organization Name:QUANTUM PHYSICAL THERAPY - PITTSFIELD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:TIZIANO
Authorized Official - Middle Name:
Authorized Official - Last Name:MAROVINO
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:734-483-9200
Mailing Address - Street 1:6180 W MICHIGAN AVENUE
Mailing Address - Street 2:
Mailing Address - City:SALINE
Mailing Address - State:MI
Mailing Address - Zip Code:48176
Mailing Address - Country:US
Mailing Address - Phone:734-434-8800
Mailing Address - Fax:734-434-8811
Practice Address - Street 1:6180 W MICHIGAN AVENUE
Practice Address - Street 2:
Practice Address - City:SALINE
Practice Address - State:MI
Practice Address - Zip Code:48176
Practice Address - Country:US
Practice Address - Phone:734-434-8800
Practice Address - Fax:734-434-8811
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-24
Last Update Date:2009-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty