Provider Demographics
NPI:1902104607
Name:THERAMEDIC REHAB INC.
Entity Type:Organization
Organization Name:THERAMEDIC REHAB INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:PANKAJ
Authorized Official - Middle Name:
Authorized Official - Last Name:MAMTORA
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:248-565-4040
Mailing Address - Street 1:12603 SOUTHWEST FWY STE 101
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:TX
Mailing Address - Zip Code:77477-3841
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:12603 SOUTHWEST FWY STE 101
Practice Address - Street 2:
Practice Address - City:STAFFORD
Practice Address - State:TX
Practice Address - Zip Code:77477-3841
Practice Address - Country:US
Practice Address - Phone:248-565-4000
Practice Address - Fax:248-565-4030
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-03
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4704Medicare PIN