1083019277 NPI number — EMPOWER PHYSICAL THERAPY AND FITNESS

Table of content: SANDRA J. KNUDSEN M.D. (NPI 1235136078)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083019277 NPI number — EMPOWER PHYSICAL THERAPY AND FITNESS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EMPOWER PHYSICAL THERAPY AND FITNESS
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1083019277
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/30/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
20554 HALL RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CLINTON TOWNSHIP
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48038-5326
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
586-868-7000
Provider Business Mailing Address Fax Number:
586-868-7007

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15501 METROPOLITAN PKWY
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
CLINTON TOWNSHIP
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48036-1684
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
586-228-7000
Provider Business Practice Location Address Fax Number:
586-228-7007
Provider Enumeration Date:
10/30/2014

Additional Information

Authorized Official

Authorized Official Last Name:
THANGAMUTHU
Authorized Official First Name:
RAJENDRAN
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER/PHYSICAL THERAPIST
Authorized Official Telephone Number:
248-890-8000

Provider Taxonomy Codes

  • Taxonomy code: 225200000X , with the licence number:  5502003513 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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