Healthcare Provider Details

I. General information

NPI: 1356420731
Provider Name (Legal Business Name): MICHIGAN REHABILITATION & PHYSICAL THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24261 GREENFIELD RD SUITE # B
SOUTHFIELD MI
48075-3117
US

IV. Provider business mailing address

24261 GREENFIELD RD SUITE # B
SOUTHFIELD MI
48075-3117
US

V. Phone/Fax

Practice location:
  • Phone: 248-569-9254
  • Fax:
Mailing address:
  • Phone: 248-569-9254
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License Number5501001299
License Number StateMI

VIII. Authorized Official

Name: MR. EJAZ CHAUDHRY
Title or Position: ADMINISTRATOR
Credential: PT
Phone: 248-569-9254