OrganizationSpecialized Physical Therapy LlcPhysical TherapistRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPractice Address49783 Annandale Dr, Canton, MI 48187-2159(313) 414-1042PECOS EnrollmentBased on the most recent information from CMS, provider Specialized Physical Therapy Llc does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 2 days ago.Profile DetailsProvider ID1396356176Provider TypeOrganizationFull NameSpecialized Physical Therapy LlcSubpartNoEnumeration Date8/13/2020Last Updated8/26/2020Contact InformationPractice LocationPractice Address49783 Annandale Dr, Canton, MI 48187-2159Phone(313) 414-1042FaxUnlisted FaxMailing LocationMailing Address49783 Annandale Dr, Canton, MI 48187-2159Phone(313) 414-1042FaxUnlisted FaxAuthorized OfficialNameJeevanandam, Kishore (Owner)Phone(313) 414-1042Provider TaxonomiesCodeDescriptionLicenseCode225100000XPrimaryDescriptionPhysical TherapistRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersLicenseUnlisted IssuerProvider IdentifiersIDDescriptionIssuerID1740578095DescriptionOtherIssuerNPI- INDID1063981421DescriptionOtherIssuerNPI- IND