Provider Demographics
NPI:1124786470
Name:MELVINDALE PHYSICAL THERAPY SPECIALISTS
Entity type:Organization
Organization Name:MELVINDALE PHYSICAL THERAPY SPECIALISTS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DPT., OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DALIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MHAID
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:313-436-4984
Mailing Address - Street 1:2928 OAKWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:MELVINDALE
Mailing Address - State:MI
Mailing Address - Zip Code:48122-1244
Mailing Address - Country:US
Mailing Address - Phone:313-436-4984
Mailing Address - Fax:313-436-4975
Practice Address - Street 1:2928 OAKWOOD BLVD
Practice Address - Street 2:
Practice Address - City:MELVINDALE
Practice Address - State:MI
Practice Address - Zip Code:48122-1244
Practice Address - Country:US
Practice Address - Phone:313-436-4984
Practice Address - Fax:313-436-4975
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-03
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty