Healthcare Provider Details

I. General information

NPI: 1093933806
Provider Name (Legal Business Name): LMT REHABILITATION ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2007
Last Update Date: 07/23/2021
Certification Date: 07/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 SOUTH BLVD E STE 120 WELLPOINTE CENTER
ROCHESTER HILLS MI
48307-6115
US

IV. Provider business mailing address

30701 BARRINGTON ST STE 100
MADISON HEIGHTS MI
48071-5114
US

V. Phone/Fax

Practice location:
  • Phone: 248-852-0860
  • Fax: 248-852-0901
Mailing address:
  • Phone: 248-616-1170
  • Fax: 248-589-9875

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081H0002X
TaxonomyHospice and Palliative Medicine (Physical Medicine & Rehabilitation) Physician
License Number208100000X
License Number StateMI

VIII. Authorized Official

Name: AMY W THOMAS
Title or Position: PRACTICE MANAGER
Credential:
Phone: 248-616-1170