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Organization
MMG 1PC
Active
Organization
MMG 1PC
Active
Other names
MILLENNIUN PHYSICAL THERAPY CENTER
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GEOFFREY A. TRIVAX M.D. (PRESIDENT)
(248) 354-9666
Entity
Organization
Contact information
Practice address
26400 W 12 MILE RD, SUITE 25, SOUTHFIELD, MI 48034-1700
(248) 864-4444
(248) 864-4445
Mailing address
29992 NORTHWESTERN HWY STE C, FARMINGTON HILLS, MI 48334-3292
(248) 851-1430
(248) 851-5182
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
30044
BLUE SHIELD
MI
Enumeration date
06/27/2007
Last updated
09/20/2018
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