Provider Demographics
NPI:1053733550
Name:BLUE SPRINGS PHYSICAL THERAPY LLC
Entity type:Organization
Organization Name:BLUE SPRINGS PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLLAWAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-543-2070
Mailing Address - Street 1:1202 CATALPA DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48067-1127
Mailing Address - Country:US
Mailing Address - Phone:248-543-2070
Mailing Address - Fax:248-543-2056
Practice Address - Street 1:1202 CATALPA DR
Practice Address - Street 2:SUITE B
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48067-1127
Practice Address - Country:US
Practice Address - Phone:248-543-2070
Practice Address - Fax:248-543-2056
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-17
Last Update Date:2014-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy