| NPI | 1801149695 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK S FUQUA Owner 248-566-3525 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2000X Clinic/Center, Physical Therapy |
| Additional Taxonomies | 225100000X Physical Therapist |
| Enumeration Date | 2012-10-18 |
| Last Update Date | 2024-02-15 |