1487833844 NPI number — FUNCTIONAL PHYSICAL THERAPY OF ROYAL OAK

Table of content: ASHLEY NICOLE LEWIS MD (NPI 1194220582)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487833844 NPI number — FUNCTIONAL PHYSICAL THERAPY OF ROYAL OAK

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FUNCTIONAL PHYSICAL THERAPY OF ROYAL OAK
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:
1487833844
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/01/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4206 PONTIAC LAKE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WATERFORD
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48328-1261
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-673-2762
Provider Business Mailing Address Fax Number:
248-673-3347

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3216 ROCHESTER RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROYAL OAK
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48073-3507
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-673-2762
Provider Business Practice Location Address Fax Number:
248-673-3347
Provider Enumeration Date:
11/01/2007

Additional Information

Authorized Official

Authorized Official Last Name:
DOSHI
Authorized Official First Name:
AKANT
Authorized Official Middle Name:
R
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
248-673-2762

Provider Taxonomy Codes

  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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