Provider Demographics
NPI:1427550482
Name:HOOVER PHYSICAL THERAPY LLC
Entity type:Organization
Organization Name:HOOVER PHYSICAL THERAPY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:RAMA
Authorized Official - Middle Name:T
Authorized Official - Last Name:GERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-217-7327
Mailing Address - Street 1:33118 WENDY DR
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48310-6471
Mailing Address - Country:US
Mailing Address - Phone:248-217-7327
Mailing Address - Fax:586-920-2678
Practice Address - Street 1:28671 HOOVER RD
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48093
Practice Address - Country:US
Practice Address - Phone:248-217-7327
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-06
Last Update Date:2018-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation PractitionerGroup - Single Specialty
No261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI=========OtherPRIVATE INSURANCE
MI=========OtherBCBS
MI=========OtherBULE CROSS