1932632627 NPI number — JOHNSON & JOHNSON P.T. L.L.C

Table of content: TRACY DIONNE POWERS LPC (NPI 1326691023)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932632627 NPI number — JOHNSON & JOHNSON P.T. L.L.C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JOHNSON & JOHNSON P.T. L.L.C
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:
1932632627
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/13/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
21700 GREENFIELD RD
Provider Second Line Business Mailing Address:
SUITE 215
Provider Business Mailing Address City Name:
OAK PARK
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48237-2581
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-268-4248
Provider Business Mailing Address Fax Number:
248-268-4857

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
21700 GREENFIELD RD
Provider Second Line Business Practice Location Address:
SUITE 215
Provider Business Practice Location Address City Name:
OAK PARK
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48237-2581
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-268-4248
Provider Business Practice Location Address Fax Number:
248-268-4857
Provider Enumeration Date:
04/10/2017

Additional Information

Authorized Official

Authorized Official Last Name:
BROWN
Authorized Official First Name:
LORINE
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
248-268-4248

Provider Taxonomy Codes

  • Taxonomy code: 305R00000X , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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