Healthcare Provider Details

I. General information

NPI: 1124226519
Provider Name (Legal Business Name): MODERN PHYSICAL THERAPY & REHAB, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4700 GREENFIELD RD LOWER LEVEL
DEARBORN MI
48126-4124
US

IV. Provider business mailing address

4700 GREENFIELD RD LOWER LEVEL
DEARBORN MI
48126-4124
US

V. Phone/Fax

Practice location:
  • Phone: 313-624-9470
  • Fax:
Mailing address:
  • Phone: 313-624-9470
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number StateMI

VIII. Authorized Official

Name: MR. FAISAL RIAZ AHMAD
Title or Position: PRESIDENT
Credential:
Phone: 313-624-9470