Provider Demographics
NPI:1972719474
Name:NOVI DPT LLC
Entity type:Organization
Organization Name:NOVI DPT LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:BAILEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-679-5396
Mailing Address - Street 1:21600 NOVI RD
Mailing Address - Street 2:STE 600 D
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48375-5605
Mailing Address - Country:US
Mailing Address - Phone:248-679-5396
Mailing Address - Fax:248-679-5397
Practice Address - Street 1:21600 NOVI RD STE 400
Practice Address - Street 2:
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48375-5605
Practice Address - Country:US
Practice Address - Phone:248-679-5396
Practice Address - Fax:248-679-5397
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-14
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501012100225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty