1326650011 NPI number — PHYSICAL THERAPY CENTER FOR SPORTS AND PERFORMING ARTS, PLLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326650011 NPI number — PHYSICAL THERAPY CENTER FOR SPORTS AND PERFORMING ARTS, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PHYSICAL THERAPY CENTER FOR SPORTS AND PERFORMING ARTS, PLLC
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:
1326650011
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/01/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1034 WHITTIER RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GROSSE POINTE PARK
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48230-1461
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
313-550-1592
Provider Business Mailing Address Fax Number:
947-600-7852

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1819 E BIG BEAVER RD STE 210
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TROY
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48083-2015
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
313-550-1592
Provider Business Practice Location Address Fax Number:
947-600-7852
Provider Enumeration Date:
08/23/2020

Additional Information

Authorized Official

Authorized Official Last Name:
PATTERSON TICHY
Authorized Official First Name:
ALEXANDRA
Authorized Official Middle Name:
MARIE
Authorized Official Title or Position:
OWNER, PHYSICAL THERAPIST
Authorized Official Telephone Number:
313-550-1592

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)





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