MEDICARE: MICHIGAN REHABILITATION CENTER LLC

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	5501011866	MI

General Provider Information

NPI Number	:	1699068510
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MICHIGAN REHABILITATION CENTER LLC

Provider Business Mailing Address
First Line	:	22146 FORD RD
Second Line	:	STE 4
City	:	DEARBORN HEIGHTS
State	:	MI
Zip	:	48127-2419
Country	:	US
Telephone Number	:	248-790-5002
Fax Number	:

Provider Business Practice Location Address
First Line	:	22146 FORD RD
Second Line	:	STE 4
City	:	DEARBORN HEIGHTS
State	:	MI
Zip	:	48127-2419
Country	:	US
Telephone Number	:	248-790-5002
Fax Number	:

Authorized Official
Title or Position	:	THERAPIST
Name	:	JOSEPH LABIB
Credential	:	THERAPIST
Telephone Number	:	248-790-5004

Provider Enumeration Date	:	05/25/2011
Last Update Date	:	05/30/2011

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