Organization
MIRACLE ONE PHYSICAL THERAPY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MALIK J FUQUA (OWNER)
(248) 808-7694
Entity
Organization
Contact information
Practice address
24800 NORTHWESTERN HWY, LEVEL 1, SOUTHFIELD, MI 48075-2319
(248) 808-7694
Mailing address
24800 NORTHWESTERN HWY, LEVEL 1, SOUTHFIELD, MI 48075-2319
(248) 808-7694
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
—
—
Other
Enumeration date
10/03/2015
Last updated
10/03/2015
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