1962435685 NPI NUMBER - GREATER DETROIT PHYSICAL THERAPY
Summary
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NPI Number |
1962435685 |
| Entity Type Code |
Organization |
| Provider Legal Name |
GREATER DETROIT PHYSICAL THERAPY |
| Provider Business Practice Location Address |
1678 S. MERRIMAN RD
WESTLAND, MI
ZIP 48186
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| Practice Location Phone Number |
(734) 721-0011 |
| Provider Taxonomy Code |
2251X0800X - Physical Therapist |
| Specialization |
Orthopedic |
| Provider Enumeration Date |
7/8/2006 |
| Last Update Date |
6/30/2008 |
NPI Number 1962435685 is assigned to an organization registered under the healthcare provider name GREATER DETROIT PHYSICAL THERAPY .
The provider is doing business as MERRIMAN MEDICAL CENTER .
The provider is a SINGLE SPECIALTY GROUP .
The provider is physically located at:
1678 S. MERRIMAN RD
WESTLAND, MI
ZIP 48186
Phone: (734) 721-0011
Fax: (734) 721-0859
The provider's authorized official is LARAN JONATHON LERNER .
The authorized official title is OWNER/PHYSICIAN and has the following contact phone number (734) 721-0011 .
The enumeration date for this NPI number is 7/8/2006 and was last updated on 6/30/2008 .
Map - Location of Practice
Taxonomy Codes
The following information regarding the scope of practice of this provider is available:
| 1 |
2251X0800X |
Physical Therapist |
Orthopedic |
LL008800 |
MI |
View Code |
Other (Legacy) Identifiers
The following legacy identifiers for this provider are available:
NPI Record
| 1 |
NPI |
1962435685 |
| 2 |
Entity Type Code |
2 |
| 3 |
Employer Identification Number EIN |
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| 4 |
Provider Organization Name Legal Business Name |
GREATER DETROIT PHYSICAL THERAPY |
| 5 |
Provider Other Organization Name |
MERRIMAN MEDICAL CENTER |
| 6 |
Provider Other Organization Name Type Code |
3 |
| 7 |
Provider First Line Business Practice Location Address |
1678 S. MERRIMAN RD |
| 8 |
Provider Business Practice Location Address City Name |
WESTLAND |
| 9 |
Provider Business Practice Location Address State Name |
MI |
| 10 |
Provider Business Practice Location Address Postal Code |
48186 |
| 11 |
Provider Business Practice Location Address Country Code If outside U S |
US |
| 12 |
Provider Business Practice Location Address Telephone Number |
7347210011 |
| 13 |
Provider Business Practice Location Address Fax Number |
7347210859 |
| 14 |
Provider Enumeration Date |
7/8/2006 |
| 15 |
Last Update Date |
6/30/2008 |
| 16 |
Authorized Official Last Name |
LERNER |
| 17 |
Authorized Official First Name |
LARAN |
| 18 |
Authorized Official Middle Name |
JONATHON |
| 19 |
Authorized Official Title or Position |
OWNER/PHYSICIAN |
| 20 |
Authorized Official Telephone Number |
7347210011 |
| 21 |
Healthcare Provider Taxonomy Code 1 |
2251X0800X |
| 22 |
Provider License Number 1 |
LL008800 |
| 23 |
Provider License Number State Code 1 |
MI |
| 24 |
Healthcare Provider Primary Taxonomy Switch 1 |
Y |
| 25 |
Is Organization Subpart |
N |
| 26 |
Authorized Official Name Prefix Text |
DR. |
| 27 |
Authorized Official Credential Text |
D.O. |
| 28 |
Healthcare Provider Taxonomy Group 1 |
193400000X SINGLE SPECIALTY GROUP |
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This page was last updated on: 5/14/2013
All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.