1548347230 NPI number — PHYSICAL THERAPY & PAIN CLINIC,INC

Table of content: BRITTNEY DANEE KOPAS CRNA (NPI 1063785475)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548347230 NPI number — PHYSICAL THERAPY & PAIN CLINIC,INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PHYSICAL THERAPY & PAIN CLINIC,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:
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:
1548347230
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/30/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
15501 METROPOLITAN PKWY
Provider Second Line Business Mailing Address:
SUITE 102
Provider Business Mailing Address City Name:
CLINTON TWP
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48036-1684
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
586-228-7000
Provider Business Mailing Address Fax Number:
586-228-7007

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15501 METROPOLITAN PKWY
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
CLINTON TWP
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48036-1684
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
586-228-7000
Provider Business Practice Location Address Fax Number:
586-228-7007
Provider Enumeration Date:
11/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
PIESKO
Authorized Official First Name:
CHRISTAL
Authorized Official Middle Name:
MARIE
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
586-228-7000

Provider Taxonomy Codes

  • Taxonomy code: 174400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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