Healthcare Provider Details

I. General information

NPI: 1275724502
Provider Name (Legal Business Name): ST. MARY REHABILITATION SERVICES L.L.C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2007
Last Update Date: 03/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42621 GARFIELD RD STE 102
CLINTON TWP MI
48038-5031
US

IV. Provider business mailing address

1580 CRIMSON DR
TROY MI
48083-5505
US

V. Phone/Fax

Practice location:
  • Phone: 586-838-2444
  • Fax:
Mailing address:
  • Phone: 586-486-3636
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateMI

VIII. Authorized Official

Name: MR. AMIR NAGY NAWAR
Title or Position: PHYSICAL THERAPIST
Credential: P.T.
Phone: 586-486-3636