Healthcare Provider Details

I. General information

NPI: 1003993312
Provider Name (Legal Business Name): CENTER FOR PHYSICAL MEDICINE & REHABILITATION PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 03/26/2024
Certification Date: 03/26/2024
Deactivation Date: 08/01/2023
Reactivation Date: 09/05/2023

III. Provider practice location address

13850 E 12 MILE RD
WARREN MI
48088-3730
US

IV. Provider business mailing address

13850 E 12 MILE RD
WARREN MI
48088-3730
US

V. Phone/Fax

Practice location:
  • Phone: 586-552-4499
  • Fax: 586-552-4878
Mailing address:
  • Phone: 586-552-4499
  • Fax: 586-552-4878

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number StateMI

VIII. Authorized Official

Name: DANIEL RYAN
Title or Position: OWNER
Credential: M.D.
Phone: 586-552-4499