Healthcare Provider Details

I. General information

NPI: 1295996320
Provider Name (Legal Business Name): PHYSICAL REHABILITATION SERVICES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2008
Last Update Date: 06/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37620 FORD RD
WESTLAND MI
48185-1924
US

IV. Provider business mailing address

37620 FORD RD
WESTLAND MI
48185-1924
US

V. Phone/Fax

Practice location:
  • Phone: 734-722-5400
  • Fax: 734-722-5454
Mailing address:
  • Phone: 734-722-5400
  • Fax: 734-722-5454

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number5501010190
License Number StateMI

VIII. Authorized Official

Name: ROBERT M BEATTY
Title or Position: OWNER/DIRECTOR
Credential: P.T.
Phone: 734-722-5400