Healthcare Provider Details

I. General information

NPI: 1851830475
Provider Name (Legal Business Name): REHAB1ST OF MICHIGAN LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2017
Last Update Date: 02/15/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

157 BALTIMORE ST SUITE 201
CUMBERLAND MD
21502-2472
US

IV. Provider business mailing address

39475 LEWIS DR SUITE 290
NOVI MI
48377-2981
US

V. Phone/Fax

Practice location:
  • Phone: 301-722-3215
  • Fax: 301-722-1450
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: MR. ROBERT BOYLE
Title or Position: MANAGING MEMBER
Credential: MPT
Phone: 301-722-3680