Provider Demographics
NPI:1538560784
Name:MERCY PHYSICAL THERAPY INC
Entity type:Organization
Organization Name:MERCY PHYSICAL THERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BAN
Authorized Official - Middle Name:
Authorized Official - Last Name:DALLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-250-2627
Mailing Address - Street 1:5961 PERRYTOWN CT
Mailing Address - Street 2:
Mailing Address - City:W BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322-1502
Mailing Address - Country:US
Mailing Address - Phone:248-250-2627
Mailing Address - Fax:
Practice Address - Street 1:5961 PERRYTOWN CT
Practice Address - Street 2:
Practice Address - City:W BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48322-1502
Practice Address - Country:US
Practice Address - Phone:248-250-2627
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-08
Last Update Date:2014-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIPENDINGOtherPENDING