Organization
PHOENIX PHYSICAL THERAPY INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
EDUARDO JACOBS RESIDENT AGENT (CEO)
(586) 557-4441
Entity
Organization
Contact information
Practice address
45628 VAN DYKE AVE, UTICA, MI 48317-5366
(586) 726-4900
Mailing address
45628 VAN DYKE AVE, UTICA, MI 48317-5366
(586) 726-4900
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
802299670
LARA
MI
Enumeration date
05/08/2019
Last updated
05/08/2019
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