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General NPI Number Information
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NPI Number | 1104033182
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Entity Type | Organization
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Legal Business Name | REHAB SPECIALISTS OF SOUTHFIELD
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Dates
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Enumeration Date | 05/17/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 29355 NORTHWESTERN HWY #200
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City | SOUTHFIELD
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State | MI
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Zip | 48034-1053
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Country | US
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Telephone | 248-353-7507
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Fax |
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Provider Business Mailing Address
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Address Line | 4777 ATKINS RD
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City | CLYDE
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State | MI
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Zip | 48049-4507
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Country | US
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Telephone | 248-353-7507
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Fax |
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Authorized Official
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Title or Position | PHYSICAL THERAPIST
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Name | RONALD BROCKEY
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Credential | PT
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Telephone | 248-353-7507
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 5501001690
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License Number State | MI
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