Provider Demographics
NPI:1699949180
Name:AUSTRALIAN INSTITUTE OF MANUAL THERAPY, PLLC
Entity type:Organization
Organization Name:AUSTRALIAN INSTITUTE OF MANUAL THERAPY, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ANGUS
Authorized Official - Middle Name:JONOTHAN
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:PHYSICAL THERAPIST
Authorized Official - Phone:734-834-2319
Mailing Address - Street 1:120 CATALPA DR
Mailing Address - Street 2:
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48067-1242
Mailing Address - Country:US
Mailing Address - Phone:248-703-9147
Mailing Address - Fax:248-556-5543
Practice Address - Street 1:120 CATALPA DR
Practice Address - Street 2:
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48067-1242
Practice Address - Country:US
Practice Address - Phone:248-703-9147
Practice Address - Fax:248-556-5543
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-16
Last Update Date:2008-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI55010108742251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI650F360770OtherBLUE CROSS BLUE SHIELD OF MICHIGAN
MIOP57410Medicare PIN