Healthcare Provider Details

I. General information

NPI: 1366692584
Provider Name (Legal Business Name): ACCESS PHYSICAL THERAPY & REHAB
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2008
Last Update Date: 10/23/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2710 S ROCHESTER RD SUITE -C
ROCHESTER HILLS MI
48307-4598
US

IV. Provider business mailing address

15700 PROVIDENCE DR APT 400
SOUTHFIELD MI
48075-3127
US

V. Phone/Fax

Practice location:
  • Phone: 248-844-9920
  • Fax: 248-844-9920
Mailing address:
  • Phone: 586-344-6353
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberB96203
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateMI
# 4
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number StateMI
# 5
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number StateMI

VIII. Authorized Official

Name: MR. GIGI JOHN
Title or Position: PHYSICAL THERAPIST
Credential:
Phone: 586-344-6353