Provider Demographics
NPI:1730431214
Name:ADVANTAGE PROFESSIONAL REHAB SERVICES LTD
Entity type:Organization
Organization Name:ADVANTAGE PROFESSIONAL REHAB SERVICES LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MUHAMMAH
Authorized Official - Middle Name:SAEED
Authorized Official - Last Name:TARIQ
Authorized Official - Suffix:
Authorized Official - Credentials:BSC
Authorized Official - Phone:248-443-2499
Mailing Address - Street 1:15565 NORTHLAND DR.
Mailing Address - Street 2:208 E.
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075
Mailing Address - Country:US
Mailing Address - Phone:248-443-2499
Mailing Address - Fax:248-443-2599
Practice Address - Street 1:15565 NORTHLAND DR.
Practice Address - Street 2:SUITE 208 E.
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075
Practice Address - Country:US
Practice Address - Phone:248-443-2499
Practice Address - Fax:248-443-2599
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-09
Last Update Date:2012-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501012711305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service