| Brookside Pediatric Therapy Llc | |
|
39650 Orchard Hill Pl Novi MI 48375-5392 | |
| (248) 747-4263 | |
| Not Available |
| Full Name | Brookside Pediatric Therapy Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 39650 Orchard Hill Pl, Novi, Michigan |
| Authorized Official Name and Position | Yasser Mansour (CEO) |
| Authorized Official Contact | 3132074645 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Brookside Pediatric Therapy Llc 39650 Orchard Hill Pl Novi MI 48375-5392 Ph: (248) 266-1188 | Brookside Pediatric Therapy Llc 39650 Orchard Hill Pl Novi MI 48375-5392 Ph: (248) 747-4263 |
| NPI Number | 1467225946 |
|---|---|
| Provider Enumeration Date | 11/06/2023 |
| Last Update Date | 10/07/2024 |
| Certification Date | 10/07/2024 |
| Medicare PECOS PAC ID | 0648623504 |
|---|---|
| Medicare Enrollment ID | O20240731000488 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1467225946 | NPI | - | NPPES |
| Provider Name | Lama Mansour |
|---|---|
| Provider Type | Practitioner - Qualified Speech Language Pathologist |
| Provider Identifiers | NPI Number: 1447621438 PECOS PAC ID: 0446539803 Enrollment ID: I20161227001394 |
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