Organization
ORTHOPEDIC EDGE LLC
Active
Organization
ORTHOPEDIC EDGE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ERICK B FOUNTAIN PT (MEMBER)
(248) 761-3530
Entity
Organization
Contact information
Practice address
51064 FILOMENA DR, SHELBY TWP, MI 48315-2937
(586) 566-5116
(586) 566-5146
Mailing address
51064 FILOMENA DR, SHELBY TWP, MI 48315-2937
(586) 566-5116
(586) 566-5146
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
5501010159
MI
261QP2000X
Physical Therapy Clinic/Center
5501010776
MI
Other
Enumeration date
06/11/2008
Last updated
06/11/2008
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