Provider Demographics
NPI:1902780711
Name:PHYSICAL THERAPY SPECIALISTS OF DEARBORN LLC
Entity type:Organization
Organization Name:PHYSICAL THERAPY SPECIALISTS OF DEARBORN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:MITTEER
Authorized Official - Suffix:
Authorized Official - Credentials:CREDENTIALING
Authorized Official - Phone:616-581-6116
Mailing Address - Street 1:14650 W WARREN AVE
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48126-1799
Mailing Address - Country:US
Mailing Address - Phone:313-850-2918
Mailing Address - Fax:
Practice Address - Street 1:14650 W WARREN AVE
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126-1799
Practice Address - Country:US
Practice Address - Phone:313-850-2918
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-08-04
Last Update Date:2025-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy