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General NPI Number Information
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NPI Number | 1073961249
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Entity Type | Organization
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Legal Business Name | JC REHABILITATION & FITNESS, LLC
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Dates
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Enumeration Date | 05/29/2016
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Last Update Date | 12/28/2019
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Provider Practice Location Address
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Address Line | 38904 DEQUINDRE RD
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City | STERLING HEIGHTS
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State | MI
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Zip | 48310-2890
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Country | US
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Telephone | 586-580-3929
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Fax |
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Provider Business Mailing Address
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Address Line | 2338 AUBURN RD
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City | SHELBY TOWNSHIP
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State | MI
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Zip | 48317-3809
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Country | US
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Telephone | 586-580-3929
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Fax | 586-580-3785
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Authorized Official
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Title or Position | MANAGER
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Name | JEFFREY KASHAT
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Credential |
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Telephone | 248-519-3084
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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