GREATER DETROIT PHYSICAL THERAPY (MERRIMAN MEDICAL CENTER) - NPI NUMBER 1962435685

Summary

Provider Name: GREATER DETROIT PHYSICAL THERAPY (MERRIMAN MEDICAL CENTER)

NPI Number: 1962435685

Clasification: Physical Therapist (2251X0800X)

Specialization: Orthopedic

Address:
1678 S. MERRIMAN RD
WESTLAND, MI
ZIP 48186

Phone Number: (734) 721-0011



Detailed Information

GREATER DETROIT PHYSICAL THERAPY is an orthopedic physical therapist in Westland, MI. The assigned NPI number for this provider is 1962435685 and is registered as an organization entity type and is a single specialty group.
The provider Is Doing Business As Merriman Medical Center.

The provider's business address is:

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

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Taxonomy Codes

The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1 2251X0800X Physical Therapist Orthopedic LL008800 MI Yes

NPI Record

No. Field Name Field Value
1 NPI 1962435685
2 Entity Type Code 2
3 Employer Identification Number EIN
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: 4/14/2014
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