Organization
TRISHARD P.C.
Active
Other names
Michigan Therapy Institute
Organization subpart
No
Provider details
NPI number
Authorized official
PATRICIA ANN PANTELLI MA,CCC-SLP (ADMINISTRATOR)
(248) 568-3563
Entity
Organization
Contact information
Practice address
2117 E 11 MILE RD, WARREN, MI 48092-3553
(586) 573-4684
(586) 573-2575
Mailing address
2117 E 11 MILE RD, WARREN, MI 48092-3553
(586) 573-4684
(586) 573-2575
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
—
MI
261QR0400X
Rehabilitation Clinic/Center
Primary
—
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
30628
BLUE CROSS BLUE SHIELD
MI
Enumeration date
10/10/2005
Last updated
03/14/2023
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