1457804460 NPI number — DEARBORN PHYSICAL THERAPY LTD.

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 1457804460 NPI number — DEARBORN PHYSICAL THERAPY LTD.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DEARBORN PHYSICAL THERAPY LTD.
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:
6
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:
1457804460
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/26/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
25511 VAN DYKE AVE
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
CENTER LINE
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48015-1834
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
586-578-9570
Provider Business Mailing Address Fax Number:
586-578-9577

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
25511 VAN DYKE AVE
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
CENTER LINE
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48015-1834
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
586-578-9570
Provider Business Practice Location Address Fax Number:
586-578-9577
Provider Enumeration Date:
07/26/2016

Additional Information

Authorized Official

Authorized Official Last Name:
BINSTEIN
Authorized Official First Name:
RICHARD
Authorized Official Middle Name:
Authorized Official Title or Position:
VP/AUTHORIZED OFFICIAL
Authorized Official Telephone Number:
713-297-7000

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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