Provider Demographics
NPI:1427086271
Name:GARBACZ, JEFFREY MICHAEL (PT)
Entity type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:MICHAEL
Last Name:GARBACZ
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23852 MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124-1829
Mailing Address - Country:US
Mailing Address - Phone:313-565-4222
Mailing Address - Fax:313-565-8703
Practice Address - Street 1:1422 N MONROE ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:MI
Practice Address - Zip Code:48162-4211
Practice Address - Country:US
Practice Address - Phone:734-243-0300
Practice Address - Fax:734-243-3066
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2011-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501011485225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP09920005Medicare ID - Type Unspecified
MI0P09920Medicare PIN