Healthcare Provider Details

I. General information

NPI: 1699829119
Provider Name (Legal Business Name): FUNCTIONAL REHAB SERVICES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2007
Last Update Date: 10/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2575 MCLEOD DR N SUITE B
SAGINAW MI
48604-2857
US

IV. Provider business mailing address

2575 MCLEOD DR N SUITE B
SAGINAW MI
48604-2857
US

V. Phone/Fax

Practice location:
  • Phone: 989-921-1132
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320700000X
TaxonomyPhysical Disabilities Residential Treatment Facility
License Number02952C
License Number StateMI

VIII. Authorized Official

Name: MUNIFA MOHIBI
Title or Position: ADMINISTRATOR PT
Credential:
Phone: 989-921-1132