Healthcare Provider Details

I. General information

NPI: 1871675447
Provider Name (Legal Business Name): DEQUINDRE PHYSICAL THERAPY & REHAB SERVICE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2006
Last Update Date: 04/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41069 DEQUINDRE ROAD SUITE 102
TROY MI
48085-6730
US

IV. Provider business mailing address

41069 DEQUINDRE ROAD SUITE 102
TROY MI
48085-6730
US

V. Phone/Fax

Practice location:
  • Phone: 248-879-9400
  • Fax: 248-879-2348
Mailing address:
  • Phone: 248-879-9400
  • Fax: 248-879-2348

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: MR. MARKUS M MUNGER
Title or Position: OWNER
Credential: PT
Phone: 248-879-9400