| Organization Name: | ORTHOPEDIC EDGE LLC |
| NPI Number: | 1164682399 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | ERICK B FOUNTAIN (MEMBER) |
| Mailing Address: | 51064 Filomena Dr Shelby Twp |
| State: | MI US |
| Postal Code: | 483152937 |
| Phone Number: | 5865665116 |
| Fax Number: | 5865665146 |
| NPI Enumeration Date: | 06/11/2008 |
| NPI Last Update Date: | 06/11/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QP2000X |
| License Number: | 5501010776 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | MI |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Physical Therapy |
| Taxonomy Definition: | |