Healthcare Provider Details

I. General information

NPI: 1255786661
Provider Name (Legal Business Name): SOUTHFIELD REHAB CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2016
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18000 W 9 MILE RD STE 510
SOUTHFIELD MI
48075-4013
US

IV. Provider business mailing address

18000 W 9 MILE RD STE 510
SOUTHFIELD MI
48075-4013
US

V. Phone/Fax

Practice location:
  • Phone: 248-304-1100
  • Fax: 248-304-1102
Mailing address:
  • Phone: 248-304-1100
  • Fax: 248-304-1102

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number5501006421
License Number StateMI

VIII. Authorized Official

Name: WILLIAM MCREYNOLDS
Title or Position: PRESIDENT
Credential:
Phone: 248-304-1100