Organization
SOUVA PT AND PERFORMANCE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JACOB BRAD SOUVA DPT (OWNER)
(586) 569-1621
Entity
Organization
Contact information
Practice address
51220 VAN DYKE AVE, SHELBY TOWNSHIP, MI 48316-4440
(586) 210-0530
Mailing address
71575 JULIUS DR, BRUCE TOWNSHIP, MI 48065-3187
(586) 569-1621
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
—
—
Other
Enumeration date
11/14/2022
Last updated
09/09/2024
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