Provider Demographics
NPI:1720153430
Name:PREFERRED PHYSICAL THERAPY SERVICES P C
Entity Type:Organization
Organization Name:PREFERRED PHYSICAL THERAPY SERVICES P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:LORELEE
Authorized Official - Middle Name:
Authorized Official - Last Name:JACINTO
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:313-724-6336
Mailing Address - Street 1:5837 W VERNOR HWY
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48209-2159
Mailing Address - Country:US
Mailing Address - Phone:313-724-6336
Mailing Address - Fax:313-724-6379
Practice Address - Street 1:5837 W VERNOR HWY
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48209-2159
Practice Address - Country:US
Practice Address - Phone:313-724-6336
Practice Address - Fax:313-724-6379
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2020-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical TherapyGroup - Single Specialty