Provider Demographics
NPI:1962438440
Name:ORTHO CARE PHYSICAL THERAPY, INC.
Entity type:Organization
Organization Name:ORTHO CARE PHYSICAL THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:APOSTOLOS
Authorized Official - Middle Name:
Authorized Official - Last Name:KERASIOTIS
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:586-294-9030
Mailing Address - Street 1:30695 LITTLE MACK AVE
Mailing Address - Street 2:SUITE 600
Mailing Address - City:ROSEVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48066-1771
Mailing Address - Country:US
Mailing Address - Phone:586-294-9030
Mailing Address - Fax:586-294-9033
Practice Address - Street 1:30695 LITTLE MACK AVE
Practice Address - Street 2:SUITE 600
Practice Address - City:ROSEVILLE
Practice Address - State:MI
Practice Address - Zip Code:48066-1771
Practice Address - Country:US
Practice Address - Phone:586-294-9030
Practice Address - Fax:586-294-9033
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-25
Last Update Date:2008-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501002451261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI30476OtherBCBS PROVIDER
MI30476OtherBCBS PROVIDER