Healthcare Provider Details

I. General information

NPI: 1700551488
Provider Name (Legal Business Name): RABEAH BEYDOUN PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2021
Last Update Date: 03/20/2026
Certification Date: 03/20/2026
Deactivation Date: 11/22/2021
Reactivation Date: 12/08/2021

III. Provider practice location address

5871 TELEGRAPH RD
TAYLOR MI
48180-1214
US

IV. Provider business mailing address

5871 TELEGRAPH RD
TAYLOR MI
48180-1214
US

V. Phone/Fax

Practice location:
  • Phone: 313-277-9200
  • Fax: 313-277-9686
Mailing address:
  • Phone: 313-277-9200
  • Fax: 313-277-9686

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5501019995
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: