Healthcare Provider Details

I. General information

NPI: 1265784482
Provider Name (Legal Business Name): COMPLETE REHABILITATION INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2012
Last Update Date: 10/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30020 SCHOENHERR RD
WARREN MI
48088-3125
US

IV. Provider business mailing address

2075 W BIG BEAVER RD SUITE 601
TROY MI
48084-3407
US

V. Phone/Fax

Practice location:
  • Phone: 586-775-5268
  • Fax:
Mailing address:
  • Phone: 248-649-3755
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MARYJO LAFATA
Title or Position: CHIEF OPERATING OFFICER
Credential: COO
Phone: 248-649-3755