Provider Demographics
NPI:1982957627
Name:ABYSSINIA LOVE KNOT POST TRAUMA CARE,LLC
Entity type:Organization
Organization Name:ABYSSINIA LOVE KNOT POST TRAUMA CARE,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:SAMANTHA
Authorized Official - Middle Name:
Authorized Official - Last Name:TURNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-262-7914
Mailing Address - Street 1:18591 W 10 MILE RD STE 4
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-2619
Mailing Address - Country:US
Mailing Address - Phone:248-262-7914
Mailing Address - Fax:
Practice Address - Street 1:18591 W 10 MILE RD STE 4
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-2619
Practice Address - Country:US
Practice Address - Phone:248-262-7914
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-18
Last Update Date:2012-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy