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NPI Code Detail

MEDICARE: TOTAL CARE PHYSICAL THERAPY & REHABILITATION, INC

MEDICARE: TOTAL CARE PHYSICAL THERAPY & REHABILITATION, 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
1261QR0400XRehabilitation Clinic/CenterMI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1P-63118OTHERMABLUE CARE NETWORK
2P-236731OTHERMIHAP
330695OTHERMABCBS OF MICHIGAN
45274758OTHERMAAETNA

General Provider Information

NPI Number : 1669479564
Entity Type Code : Organization
Provider Name (Legal Business Name) : TOTAL CARE PHYSICAL THERAPY & REHABILITATION, INC
Provider Business Mailing Address
First Line : 17950 WOODWARD AVE
Second Line : 2ND FLOOR
City : DETROIT
State : MI
Zip : 48203-2260
Country : US
Telephone Number : 313-865-5200
Fax Number : 313-865-5300
Provider Business Practice Location Address
First Line : 17950 WOODWARD AVE
Second Line : 2ND FLOOR
City : DETROIT
State : MI
Zip : 48203-2260
Country : US
Telephone Number : 313-865-5200
Fax Number : 313-865-5300
Authorized Official
Title or Position : ALTERNATE ADMINISTRATOR, OT
Name : MR. VIJAY MISHRA
Credential : O.T.
Telephone Number : 586-872-5133
Provider Enumeration Date : 07/07/2005
Last Update Date : 07/21/2022

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