# LEVEL 11 PHYSICAL THERAPY

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Level 11
- **Organization subpart:** No

## Provider details

- **NPI number:** 1730317785
- **Authorized official:** ANGIE MATTINGLY (MGR PROVIDER ENROLLMENT)
- **Authorized official phone:** (502) 420-2512

## Contact information

- **Practice address:** 10483 DIXIE HWY, HOLLY, MI 48442-9210
- **Practice address phone:** (810) 771-7686
- **Practice address fax:** (810) 771-7685
- **Mailing address:** 10483 DIXIE HWY, HOLLY, MI 48442-9210
- **Mailing address phone:** (810) 771-7686
- **Mailing address fax:** (810) 771-7685

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QR0400X | Rehabilitation Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 06/29/2009
- **Last updated:** 09/26/2023