Provider Demographics
NPI:1447013941
Name:MICHIGAN FYZPT-II FYZICAL
Entity type:Organization
Organization Name:MICHIGAN FYZPT-II FYZICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TIMMY
Authorized Official - Middle Name:
Authorized Official - Last Name:NAFSO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-826-5600
Mailing Address - Street 1:16925 HAGGERTY RD
Mailing Address - Street 2:
Mailing Address - City:NORTHVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48168-3955
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:16925 HAGGERTY RD
Practice Address - Street 2:
Practice Address - City:NORTHVILLE
Practice Address - State:MI
Practice Address - Zip Code:48168-3955
Practice Address - Country:US
Practice Address - Phone:248-826-5600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-06
Last Update Date:2024-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy