Healthcare Provider Details

I. General information

NPI: 1710023916
Provider Name (Legal Business Name): ADVANCED NEURO REHAB SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2007
Last Update Date: 06/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26635 WOODWARD AVENUE SUITE 101
HUNTINGTON WOODS MI
48070
US

IV. Provider business mailing address

26635 WOODWARD AVENUE SUITE 101
HUNTINGTON WOODS MI
48070-1372
US

V. Phone/Fax

Practice location:
  • Phone: 248-548-6400
  • Fax: 248-548-8885
Mailing address:
  • Phone: 248-548-6400
  • Fax: 248-548-8885

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251N0400X
TaxonomyNeurology Physical Therapist
License NumberHP050806-4301050806
License Number StateMI

VIII. Authorized Official

Name: LISA JOHNSON
Title or Position: OFFICE MANAGER
Credential:
Phone: 248-548-6400