Healthcare Provider Details

I. General information

NPI: 1831275270
Provider Name (Legal Business Name): LORDS PHYSICAL THERAPY AND REHAB SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/28/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1920 JUNCTION ST
DETROIT MI
48209-2168
US

IV. Provider business mailing address

1920 JUNCTION ST
DETROIT MI
48209-2168
US

V. Phone/Fax

Practice location:
  • Phone: 313-739-3505
  • Fax:
Mailing address:
  • Phone: 313-739-3505
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: SHAMNATH A RAHIM
Title or Position: ADMINISTRATOR
Credential: RPT
Phone: 313-297-3233