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NPI Code Detail

MEDICARE: NEW AGE PT REHAB INC

MEDICARE: NEW AGE PT REHAB 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
1261QP2000XPhysical Therapy Clinic/CenterMI

General Provider Information

NPI Number : 1760920409
Entity Type Code : Organization
Provider Name (Legal Business Name) : NEW AGE PT REHAB INC
Provider Business Mailing Address
First Line : 37522 DEQUINDRE RD
Second Line :
City : STERLING HEIGHTS
State : MI
Zip : 48310-3511
Country : US
Telephone Number : 586-438-2114
Fax Number : 586-438-2115
Provider Business Practice Location Address
First Line : 37522 DEQUINDRE RD
Second Line :
City : STERLING HEIGHTS
State : MI
Zip : 48310-3511
Country : US
Telephone Number : 586-438-2114
Fax Number : 586-438-2115
Authorized Official
Title or Position : AUTHORIZED OFFICIAL
Name : KHALID GAZGUZ
Credential :
Telephone Number : 586-438-2114
Provider Enumeration Date : 02/02/2017
Last Update Date : 02/02/2017

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