Ideal Physical Therapy Services,Inc

Primary specialty

Orthopedic Physical TherapistTaxonomy code 2251X0800X

License

55001006794 Issued in MI

Legal business name

IDEAL PHYSICAL THERAPY SERVICES,INC

Practice address

14058 W McNichols Rd
Detroit, MI 48235-3928

Phone

(313) 659-6847

Fax

(313) 659-6867

NPI assigned

Feb 23, 2016

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Kazeem A Agboola

Title

President

Phone

(313) 659-6847

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MI

Enrollment records 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1456185600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1456185600000",
    "number": "1477913127",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 99037",
            "city": "TROY",
            "state": "MI",
            "postal_code": "480999037",
            "telephone_number": "313-659-6847",
            "fax_number": "313-659-6867"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14058 W MCNICHOLS RD",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482353928",
            "telephone_number": "313-659-6847",
            "fax_number": "313-659-6867"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IDEAL PHYSICAL THERAPY SERVICES,INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-02-23",
        "last_updated": "2016-02-23",
        "status": "A",
        "authorized_official_last_name": "AGBOOLA",
        "authorized_official_first_name": "KAZEEM",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "313-659-6847",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "2251X0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist, Orthopedic",
            "state": "MI",
            "license": "55001006794",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Noori Mikhael Ibrahim, MD
• Rami Boutros Ibrahim, PHARMD, DO
• Rula Ibrahim
• Icare Nemt LLC
• Andre Ice, QMHS
• Scarlett Idema, NURSE PRACTITIONER
• Anas Idris, M.D.
• Kathleen Idriss
• Kamran Iftikhar, DO
• Jed Ohiremen Ig-Izevbekhai, DO

• Orthopedic Physical Therapist in Detroit, MI
• Providers in Detroit, MI by specialty
• Orthopedic Physical Therapist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 23, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.