Provider Demographics
NPI:1871938324
Name:AWAKENING MOVEMENTS FELDENKRAIS AND PHYSICAL THERAPY
Entity type:Organization
Organization Name:AWAKENING MOVEMENTS FELDENKRAIS AND PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:MISS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:DARLENE
Authorized Official - Last Name:PONICHTER
Authorized Official - Suffix:
Authorized Official - Credentials:MPT, GCFP
Authorized Official - Phone:248-321-0358
Mailing Address - Street 1:1775 E 14 MILE RD
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:MI
Mailing Address - Zip Code:48009-7206
Mailing Address - Country:US
Mailing Address - Phone:248-321-0358
Mailing Address - Fax:
Practice Address - Street 1:1710 E 12 MILE RD STE 103
Practice Address - Street 2:
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48073-4200
Practice Address - Country:US
Practice Address - Phone:248-321-0358
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-09
Last Update Date:2024-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501010870261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy