Organization
ST MARY PHYSICAL THERAPY AND REHABILITATION LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. SAMI FALTAS PT (OWNER)
(248) 739-9059
Entity
Organization
Contact information
Practice address
20825 MACK AVE, GROSSE POINTE WOODS, MI 48236-1485
(248) 739-9059
Mailing address
11258 REGAL DR, STERLING HEIGHTS, MI 48313-4974
(248) 739-9059
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
5501008309
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
650F329970
BLUE SHIELD OF MICHIGAN
MI
Enumeration date
03/12/2008
Last updated
02/04/2011
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