Healthcare Provider Details

I. General information

NPI: 1891906087
Provider Name (Legal Business Name): PCPT THERAPY & REHAB, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2007
Last Update Date: 08/22/2020
Certification Date:
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: 313-928-3480
  • Fax: 248-344-1056
Mailing address:
  • Phone: 313-928-3480
  • Fax: 248-344-1056

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. SARLA DEDHIA
Title or Position: ADMINISTRATOR AND PRESIDENT
Credential: P.T.
Phone: 313-928-3480