Healthcare Provider Details

I. General information

NPI: 1407710999
Provider Name (Legal Business Name): EVOLVE REHAB PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/10/2025
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6256 N TELEGRAPH RD
DEARBORN HEIGHTS MI
48127-3223
US

IV. Provider business mailing address

6256 N TELEGRAPH RD
DEARBORN HEIGHTS MI
48127-3223
US

V. Phone/Fax

Practice location:
  • Phone: 313-483-6002
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2083P0011X
TaxonomyUndersea and Hyperbaric Medicine (Preventive Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: MOHAMED RAYCHOUNI
Title or Position: MEMBER
Credential: DC
Phone: 313-483-6002