Healthcare Provider Details

I. General information

NPI: 1649472960
Provider Name (Legal Business Name): PREFERRED REHAB CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2007
Last Update Date: 10/15/2024
Certification Date: 10/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4020 VENOY RD STE 700
WAYNE MI
48184-1891
US

IV. Provider business mailing address

4020 VENOY RD STE 700
WAYNE MI
48184-1891
US

V. Phone/Fax

Practice location:
  • Phone: 734-727-1309
  • Fax: 734-727-1319
Mailing address:
  • Phone: 734-727-1309
  • Fax: 734-727-1319

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: RAVI B KUKKALLI
Title or Position: PRESIDENT/ADMINISTRATOR
Credential: PT
Phone: 734-727-1309