Provider Demographics
NPI:1881924280
Name:PHYSICAL THERAPY HEALTHCARE CENTER, P.C.
Entity type:Organization
Organization Name:PHYSICAL THERAPY HEALTHCARE CENTER, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REHAB DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DEEPAK
Authorized Official - Middle Name:A
Authorized Official - Last Name:SARDEY
Authorized Official - Suffix:
Authorized Official - Credentials:PHYSICAL THERAPIST
Authorized Official - Phone:586-677-5574
Mailing Address - Street 1:54750 MOUND RD
Mailing Address - Street 2:
Mailing Address - City:SHELBY TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48316-1706
Mailing Address - Country:US
Mailing Address - Phone:586-677-5574
Mailing Address - Fax:586-677-5578
Practice Address - Street 1:54750 MOUND RD
Practice Address - Street 2:
Practice Address - City:SHELBY TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48316-1706
Practice Address - Country:US
Practice Address - Phone:586-677-5574
Practice Address - Fax:586-677-5578
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-06
Last Update Date:2010-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501005868261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI650E05729OtherBLUE CROSS BLUE SHIELD OF MICHIGAN
MI4157105Medicaid
MI650E05729OtherBLUE CROSS BLUE SHIELD OF MICHIGAN