1104975481 NPI number — P.T. PLUS THERAPEUTIC RESOURCES, INC.

Table of content: KATHERINE MARY CZAJKA P.T. (NPI 1568500643)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104975481 NPI number — P.T. PLUS THERAPEUTIC RESOURCES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
P.T. PLUS THERAPEUTIC RESOURCES, INC.
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:
1104975481
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
26263 GIBRALTAR RD
Provider Second Line Business Mailing Address:
SUITE 700
Provider Business Mailing Address City Name:
FLAT ROCK
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48134-1579
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
734-285-6789
Provider Business Mailing Address Fax Number:
734-285-6778

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
26263 GIBRALTAR RD
Provider Second Line Business Practice Location Address:
SUITE 700
Provider Business Practice Location Address City Name:
FLAT ROCK
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48134-1579
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
734-285-6789
Provider Business Practice Location Address Fax Number:
734-285-6778
Provider Enumeration Date:
01/09/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SHARMA
Authorized Official First Name:
ANDREA
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
734-285-6789

Provider Taxonomy Codes

  • Taxonomy code: 261QP2000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 4226098 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".




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