Provider Demographics
NPI:1912503830
Name:PRYDE PHYSICAL THERAPY PLLC
Entity Type:Organization
Organization Name:PRYDE PHYSICAL THERAPY PLLC
Other - Org Name:PRYDE PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JON
Authorized Official - Middle Name:
Authorized Official - Last Name:JEFFREY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-476-5189
Mailing Address - Street 1:5536 RESEARCH DR
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48188-2261
Mailing Address - Country:US
Mailing Address - Phone:734-895-1901
Mailing Address - Fax:
Practice Address - Street 1:5536 RESEARCH DR
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48188-2261
Practice Address - Country:US
Practice Address - Phone:734-895-1901
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PRYDE ATHLETICS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-12-07
Last Update Date:2021-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty