Healthcare Provider Details

I. General information

NPI: 1902467145
Provider Name (Legal Business Name): HALO PT & REHAB
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2019
Last Update Date: 06/27/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20240 W 12 MILE RD
SOUTHFIELD MI
48076-2426
US

IV. Provider business mailing address

PO BOX 772249
DETROIT MI
48277-2249
US

V. Phone/Fax

Practice location:
  • Phone: 248-331-1400
  • Fax: 248-331-1401
Mailing address:
  • Phone: 248-331-1400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: HANADY BEYDOUN
Title or Position: OFFICE MANAGER
Credential:
Phone: 313-993-7777