Provider Demographics
NPI:1174774541
Name:POISE LLC
Entity type:Organization
Organization Name:POISE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:HEIDI
Authorized Official - Middle Name:STEINKE
Authorized Official - Last Name:MALZAHN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-349-3100
Mailing Address - Street 1:186 E MAIN ST STE 301
Mailing Address - Street 2:SUITE 301
Mailing Address - City:NORTHVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48167-2676
Mailing Address - Country:US
Mailing Address - Phone:248-349-3100
Mailing Address - Fax:248-349-4040
Practice Address - Street 1:186 E MAIN ST STE 301
Practice Address - Street 2:SUITE 301
Practice Address - City:NORTHVILLE
Practice Address - State:MI
Practice Address - Zip Code:48167-2676
Practice Address - Country:US
Practice Address - Phone:248-349-3100
Practice Address - Fax:248-349-4040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-03
Last Update Date:2009-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501011498225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOP30490Medicare PIN