Provider Demographics
NPI:1386946291
Name:QUANTUM PHYSICAL THERAPY-BELLEVILLE LLC
Entity type:Organization
Organization Name:QUANTUM PHYSICAL THERAPY-BELLEVILLE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:TIZIANO
Authorized Official - Middle Name:
Authorized Official - Last Name:MAROVINO
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:734-483-9200
Mailing Address - Street 1:11650 BELLEVILLE RD
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48111-3380
Mailing Address - Country:US
Mailing Address - Phone:734-325-2443
Mailing Address - Fax:734-325-2447
Practice Address - Street 1:11650 BELLEVILLE RD
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:MI
Practice Address - Zip Code:48111-3380
Practice Address - Country:US
Practice Address - Phone:734-325-2443
Practice Address - Fax:734-325-2447
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-29
Last Update Date:2010-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty