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General NPI Number Information
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NPI Number | 1073815361
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Entity Type | Organization
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Legal Business Name | GREATER METRO REHAB LLC
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Dates
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Enumeration Date | 11/19/2010
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Last Update Date | 11/19/2010
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Provider Practice Location Address
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Address Line | 20240 W 12 MILE RD
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City | SOUTHFIELD
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State | MI
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Zip | 48076-2426
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Country | US
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Telephone | 248-353-6880
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Fax | 734-692-6195
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Provider Business Mailing Address
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Address Line | 210 WOODBERRY DR
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City | BLOOMFIELD HILLS
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State | MI
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Zip | 48304-3561
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Country | US
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Telephone | 248-353-6880
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Fax | 734-692-6195
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Authorized Official
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Title or Position | CLINIC DIRECTOR
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Name | MS. MARCIA FOSNAUGH AVIS
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Credential | R.N.
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Telephone | 248-353-6880
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number | A106496
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License Number State | MI
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