Healthcare Provider Details

I. General information

NPI: 1780711861
Provider Name (Legal Business Name): REHABILITATION SPECIALISTS OF LIVINGSTON COUNTY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2007
Last Update Date: 10/05/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27427 SCHOENHERR RD SUITE 200
WARREN MI
48088-4729
US

IV. Provider business mailing address

27427 SCHOENHERR RD SUITE 200
WARREN MI
48088-4729
US

V. Phone/Fax

Practice location:
  • Phone: 586-757-9311
  • Fax: 586-757-9401
Mailing address:
  • Phone: 586-757-9311
  • Fax: 586-757-9401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5501001469
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number00078683
License Number StateMI

VIII. Authorized Official

Name: MR. BRADLEY PUTVIN
Title or Position: CEO, PHYSICAL THERAPIST
Credential: PT
Phone: 810-923-2361