Provider Demographics
NPI:1669912978
Name:PALMS PHYSICAL THERAPY
Entity type:Organization
Organization Name:PALMS PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:BIANCA
Authorized Official - Middle Name:DANILLIE
Authorized Official - Last Name:LEVERETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-629-7513
Mailing Address - Street 1:23300 GREENFIELD RD
Mailing Address - Street 2:113
Mailing Address - City:OAK PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48237-5237
Mailing Address - Country:US
Mailing Address - Phone:248-629-7513
Mailing Address - Fax:248-397-8437
Practice Address - Street 1:23300 GREENFIELD RD
Practice Address - Street 2:113
Practice Address - City:OAK PARK
Practice Address - State:MI
Practice Address - Zip Code:48237-5237
Practice Address - Country:US
Practice Address - Phone:248-629-7513
Practice Address - Fax:248-397-8437
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-06
Last Update Date:2017-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI=========OtherPHYSICAL THERAPY