1568850774 NPI number — PINNACLE PHYSICAL THERAPY, LLC

Table of content: DR. FOLASHADE CATHERINE AFOLABI MD (NPI 1619140100)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568850774 NPI number — PINNACLE PHYSICAL THERAPY, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PINNACLE PHYSICAL THERAPY, LLC
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:
1568850774
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/22/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
29201 TELEGRAPH RD STE 450
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SOUTHFIELD
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48034-7604
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-304-7659
Provider Business Mailing Address Fax Number:
248-479-8117

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
29201 TELEGRAPH RD STE 220
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SOUTHFIELD
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48034-1331
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-304-7776
Provider Business Practice Location Address Fax Number:
248-918-2024
Provider Enumeration Date:
12/23/2014

Additional Information

Authorized Official

Authorized Official Last Name:
HILL
Authorized Official First Name:
ABBIE
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
248-304-7659

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: 1306075551 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com