Organization
IDEAL PHYSICAL THERAPY SERVICES,INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KAZEEM A AGBOOLA (PRESIDENT)
(313) 659-6847
Entity
Organization
Contact information
Practice address
14058 W MCNICHOLS RD, DETROIT, MI 48235-3928
(313) 659-6847
(313) 659-6867
Mailing address
PO BOX 99037, TROY, MI 48099-9037
(313) 659-6847
(313) 659-6867
Taxonomy
Speciality
Code
Description
License number
State
2251X0800X
Orthopedic Physical Therapist
Primary
55001006794
MI
Other
Enumeration date
02/23/2016
Last updated
02/23/2016
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