Healthcare Provider Details

I. General information

NPI: 1053356907
Provider Name (Legal Business Name): REHABONE-CENTER FOR ORTHOPEDIC & SPORTS PHYSICAL THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37300 DEQUINDRE RD SUITE 300
STERLING HEIGHTS MI
48310-3591
US

IV. Provider business mailing address

2037 DEVEERE DR
STERLING HEIGHTS MI
48310-5853
US

V. Phone/Fax

Practice location:
  • Phone: 586-983-2498
  • Fax: 586-983-2501
Mailing address:
  • Phone: 586-883-4176
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number5501007799
License Number StateMI

VIII. Authorized Official

Name: GERVACIO MARASIGAN LAQUI
Title or Position: PRESIDENT CEO
Credential: MHSCPT,MTC,MGS
Phone: 586-983-2498