Provider Demographics
NPI:1285124412
Name:MICHIGAN PHYSICAL THERAPY GROUP, LLC
Entity type:Organization
Organization Name:MICHIGAN PHYSICAL THERAPY GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:FRANK
Authorized Official - Last Name:PAPIO
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:212-414-1111
Mailing Address - Street 1:13530 MICHIGAN AVE STE 245
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48126-3575
Mailing Address - Country:US
Mailing Address - Phone:212-414-1111
Mailing Address - Fax:
Practice Address - Street 1:13530 MICHIGAN AVE STE 245
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126-3575
Practice Address - Country:US
Practice Address - Phone:212-414-1111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-14
Last Update Date:2019-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy