Organization
MIRNA PHYSICAL THERAPY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MIRNA KAKOS (OWNER)
(248) 727-8997
Entity
Organization
Contact information
Practice address
33449 VAN DYKE AVE, STERLING HTS, MI 48312-5928
(248) 727-8997
Mailing address
33449 VAN DYKE AVE, STERLING HTS, MI 48312-5928
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PENDING
—
MI
Enumeration date
06/17/2019
Last updated
06/17/2019
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