Provider Demographics
NPI:1730366766
Name:FIRST REHAB PAIN MANAGEMENT INC.
Entity type:Organization
Organization Name:FIRST REHAB PAIN MANAGEMENT INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL BILLER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUZANNE
Authorized Official - Middle Name:N
Authorized Official - Last Name:B.
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-357-0292
Mailing Address - Street 1:PO BOX 1406
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48121-1406
Mailing Address - Country:US
Mailing Address - Phone:313-581-7971
Mailing Address - Fax:313-581-8028
Practice Address - Street 1:5237 OAKMAN BLVD
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126-4045
Practice Address - Country:US
Practice Address - Phone:313-581-7971
Practice Address - Fax:313-581-8028
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-22
Last Update Date:2008-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501003394305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5501003394OtherPHYSICAL THERAPY