Provider Demographics
NPI:1972720324
Name:UZNIS PHYSICAL THERAPY
Entity type:Organization
Organization Name:UZNIS PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF PHYSICAL THERAPY
Authorized Official - Prefix:
Authorized Official - First Name:GRETCHEN
Authorized Official - Middle Name:UZNIS
Authorized Official - Last Name:CARRON
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:313-881-5678
Mailing Address - Street 1:408 MADISON ST
Mailing Address - Street 2:
Mailing Address - City:GROSSE POINTE FARMS
Mailing Address - State:MI
Mailing Address - Zip Code:48236-3209
Mailing Address - Country:US
Mailing Address - Phone:313-886-9331
Mailing Address - Fax:
Practice Address - Street 1:18101 E WARREN AVE
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48224-1382
Practice Address - Country:US
Practice Address - Phone:313-881-5678
Practice Address - Fax:313-881-9337
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501011454174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI30392OtherBLUE CROSS
MI0094960002Medicaid
MI236548Medicare ID - Type Unspecified