MEDICARE: PRIME REHAB AND PHYSICAL THERAPY INC

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	320700000X	Physical Disabilities Residential Treatment Facility

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1457356453
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRIME REHAB AND PHYSICAL THERAPY INC

Provider Business Mailing Address
First Line	:	7140 W FORT ST
Second Line	:	STE 4
City	:	DETROIT
State	:	MI
Zip	:	48209-2917
Country	:	US
Telephone Number	:	313-357-3079
Fax Number	:	313-388-0593

Provider Business Practice Location Address
First Line	:	2900 S FORT ST
Second Line	:	STE 3
City	:	DETROIT
State	:	MI
Zip	:	48217-1061
Country	:	US
Telephone Number	:	313-388-0156
Fax Number	:	313-388-0593

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	DR. MUHAMMAD SADIQ
Credential	:
Telephone Number	:	313-357-3079

Provider Enumeration Date	:	06/16/2005
Last Update Date	:	03/07/2012

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