Provider Demographics
NPI:1306143771
Name:WAYNE COUNTY PHYSICAL THERAPY, LLC
Entity type:Organization
Organization Name:WAYNE COUNTY PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:NUSRAT
Authorized Official - Middle Name:
Authorized Official - Last Name:JAURA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-404-8589
Mailing Address - Street 1:6420 FARMINGTON RD
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322-2276
Mailing Address - Country:US
Mailing Address - Phone:248-203-1282
Mailing Address - Fax:248-203-4148
Practice Address - Street 1:1029 E SAGINAW
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48906
Practice Address - Country:US
Practice Address - Phone:248-203-1282
Practice Address - Fax:248-203-4148
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-22
Last Update Date:2011-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501014195261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy