Healthcare Provider Details

I. General information

NPI: 1689507758
Provider Name (Legal Business Name): TRI COUNTY REHAB AND PAIN MANAGEMENET LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2026
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26190 OUTER DR
LINCOLN PARK MI
48146-2084
US

IV. Provider business mailing address

26190 OUTER DR
LINCOLN PARK MI
48146-2084
US

V. Phone/Fax

Practice location:
  • Phone: 313-228-5302
  • Fax: 313-228-5304
Mailing address:
  • Phone: 313-228-5302
  • Fax: 313-228-5304

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: MOHTESHAM A TAHIR
Title or Position: PRESIDENT
Credential:
Phone: 734-512-6724