Provider Demographics
NPI:1538576475
Name:MICHIGAN PHYSICAL THERAPY AND REHAB, LLC.
Entity type:Organization
Organization Name:MICHIGAN PHYSICAL THERAPY AND REHAB, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:SOHAIL
Authorized Official - Middle Name:
Authorized Official - Last Name:KHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:586-944-9908
Mailing Address - Street 1:37522 DEQUINDRE RD STE C
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48310-3511
Mailing Address - Country:US
Mailing Address - Phone:586-944-9908
Mailing Address - Fax:586-698-2173
Practice Address - Street 1:37522 DEQUINDRE RD STE C
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48310-3511
Practice Address - Country:US
Practice Address - Phone:586-944-9908
Practice Address - Fax:586-698-2173
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-11
Last Update Date:2014-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy