Provider Demographics
NPI:1487171179
Name:LAHSER CAMPUS PHYSICAL THERAPY GROUP LLC
Entity type:Organization
Organization Name:LAHSER CAMPUS PHYSICAL THERAPY GROUP LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:TAREK
Authorized Official - Middle Name:
Authorized Official - Last Name:JAWARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-674-9800
Mailing Address - Street 1:27177 LAHSER RD STE 200
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48034-8468
Mailing Address - Country:US
Mailing Address - Phone:248-996-9420
Mailing Address - Fax:
Practice Address - Street 1:27177 LAHSER RD STE 200
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-8468
Practice Address - Country:US
Practice Address - Phone:248-996-9420
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-24
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy