Provider Demographics
NPI:1215353909
Name:HOLISTIC PHYSICAL THERAPY CENTER, LLC.
Entity type:Organization
Organization Name:HOLISTIC PHYSICAL THERAPY CENTER, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KHADRA
Authorized Official - Middle Name:A
Authorized Official - Last Name:KAHIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:810-820-4533
Mailing Address - Street 1:1170 CHARTER DRIVE SUITE C.
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532
Mailing Address - Country:US
Mailing Address - Phone:810-820-4975
Mailing Address - Fax:810-820-2134
Practice Address - Street 1:1170 CHARTER DRIVE SUITE C.
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532
Practice Address - Country:US
Practice Address - Phone:810-820-4975
Practice Address - Fax:810-820-2134
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-05
Last Update Date:2016-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty