Healthcare Provider Details

I. General information

NPI: 1306118351
Provider Name (Legal Business Name): OMEGA REHAB SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2012
Last Update Date: 02/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 HAMPTON CIR SUITE 150
ROCHESTER HILLS MI
48307-4195
US

IV. Provider business mailing address

130 HAMPTON CIR SUITE 150
ROCHESTER HILLS MI
48307-4195
US

V. Phone/Fax

Practice location:
  • Phone: 248-289-1127
  • Fax: 248-289-1196
Mailing address:
  • Phone: 248-289-1127
  • Fax: 248-289-1196

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License Number
License Number StateMI

VIII. Authorized Official

Name: MR. JOSEPH RUEFIEL
Title or Position: ADMINISTRATOR
Credential:
Phone: 248-289-1127