Healthcare Provider Details

I. General information

NPI: 1871788489
Provider Name (Legal Business Name): TOTAL REHABILITATION, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2007
Last Update Date: 01/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3375 N LINDEN RD APT 151
FLINT MI
48504-5719
US

IV. Provider business mailing address

3375 N LINDEN RD APT 151
FLINT MI
48504-5719
US

V. Phone/Fax

Practice location:
  • Phone: 810-230-1030
  • Fax:
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: TERRY L GODDARD
Title or Position: OWNER
Credential: O.T.
Phone: 810-230-1030