Provider Demographics
NPI:1992493993
Name:KANITZ PHYSIO AND WELLNESS, LLC
Entity type:Organization
Organization Name:KANITZ PHYSIO AND WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:KANITZ
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:734-735-8317
Mailing Address - Street 1:3375 5 MILE RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH LYON
Mailing Address - State:MI
Mailing Address - Zip Code:48178-9662
Mailing Address - Country:US
Mailing Address - Phone:734-735-8317
Mailing Address - Fax:
Practice Address - Street 1:3375 5 MILE RD
Practice Address - Street 2:
Practice Address - City:SOUTH LYON
Practice Address - State:MI
Practice Address - Zip Code:48178-9662
Practice Address - Country:US
Practice Address - Phone:734-735-8317
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-27
Last Update Date:2023-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty