Healthcare Provider Details

I. General information

NPI: 1508086471
Provider Name (Legal Business Name): NEUROLAB
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

47601 GRAND RIVER AVE SUITE A 222
NOVI MI
48374-1233
US

IV. Provider business mailing address

4385 MOTORWAY DR
WATERFORD MI
48328-3451
US

V. Phone/Fax

Practice location:
  • Phone: 248-342-9907
  • Fax: 248-681-8077
Mailing address:
  • Phone: 249-342-9907
  • Fax: 248-681-8077

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code2251E1300X
TaxonomyClinical Electrophysiology Physical Therapist
License Number1276 MI
License Number StateMI

VIII. Authorized Official

Name: DR. JOHN PALAZZO
Title or Position: DIRECTOR
Credential: DSC, PT, ECS
Phone: 248-342-9907