MEDICARE: DEVINE PHYSICAL THERAPY AND REHABILITATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	5501005927	MI
2	225X00000X	Occupational Therapist	5201001527	MI
3	225X00000X	Occupational Therapist	5201004429	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	30777	OTHER	MI	BCBS OF MI FACILITY ID#
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1265574305
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DEVINE PHYSICAL THERAPY AND REHABILITATION

Provider Business Mailing Address
First Line	:	16820 GREENFIELD RD
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48235-3703
Country	:	US
Telephone Number	:	313-273-7188
Fax Number	:	313-273-7228

Provider Business Practice Location Address
First Line	:	16820 GREENFIELD RD
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48235-3703
Country	:	US
Telephone Number	:	313-273-7188
Fax Number	:	313-273-7228

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MR. UCHE NWAGWU
Credential	:
Telephone Number	:	313-273-7188

Provider Enumeration Date	:	02/13/2007
Last Update Date	:	09/11/2025

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Directions to “DEVINE PHYSICAL THERAPY AND REHABILITATION ” Practice Location

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