Miracle One Physical Therapy LLC

Primary specialty

Physical Therapy Clinic/CenterTaxonomy code 261QP2000X

Legal business name

MIRACLE ONE PHYSICAL THERAPY LLC

Practice address

24800 Northwestern Hwy
Level 1
Southfield, MI 48075-2319

Phone

(248) 808-7694

NPI assigned

Oct 3, 2015

Organization subpart

No

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

Authorized official

Name

Malik J Fuqua

Title

Owner

Phone

(248) 808-7694

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1443830400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1443830400000",
    "number": "1477923431",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "24800 NORTHWESTERN HWY",
            "address_2": "LEVEL 1",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480752319",
            "telephone_number": "248-808-7694"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "24800 NORTHWESTERN HWY",
            "address_2": "LEVEL 1",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480752319",
            "telephone_number": "248-808-7694"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIRACLE ONE PHYSICAL THERAPY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-10-03",
        "last_updated": "2015-10-03",
        "status": "A",
        "authorized_official_last_name": "FUQUA",
        "authorized_official_first_name": "MALIK",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "248-808-7694"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jonathan Miodownik, D.M.D.
• Gustavo Alberto Mirabal, MEDICAL STUDENT MS4
• Miracle Care HC LLC
• Miracle Home Care, Inc.
• Miracle Loveknot Physical Therapy LLC
• Abigail Miramon Urias
• Charles William Miriani
• Marah Leonie Mischakoff, MA, LPC
• Misfits Regrowth Counseling PLLC
• Edward Y Mishal, D.O

• Physical Therapy Clinic/Center in Southfield, MI
• Providers in Southfield, MI by specialty
• Physical Therapy Clinic/Center in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 3, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.