Provider Demographics
NPI:1548347230
Name:PHYSICAL THERAPY & PAIN CLINIC,INC
Entity type:Organization
Organization Name:PHYSICAL THERAPY & PAIN CLINIC,INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTAL
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:PIESKO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:586-228-7000
Mailing Address - Street 1:15501 METROPOLITAN PKWY
Mailing Address - Street 2:SUITE 102
Mailing Address - City:CLINTON TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48036-1684
Mailing Address - Country:US
Mailing Address - Phone:586-228-7000
Mailing Address - Fax:586-228-7007
Practice Address - Street 1:15501 METROPOLITAN PKWY
Practice Address - Street 2:SUITE 102
Practice Address - City:CLINTON TWP
Practice Address - State:MI
Practice Address - Zip Code:48036-1684
Practice Address - Country:US
Practice Address - Phone:586-228-7000
Practice Address - Fax:586-228-7007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2008-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI236578Medicare Oscar/Certification