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General NPI Number Information
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NPI Number | 1124226519
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Entity Type | Organization
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Legal Business Name | MODERN PHYSICAL THERAPY & REHAB, INC.
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Dates
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Enumeration Date | 07/06/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 4700 GREENFIELD RD LOWER LEVEL
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City | DEARBORN
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State | MI
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Zip | 48126-4124
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Country | US
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Telephone | 313-624-9470
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Fax |
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Provider Business Mailing Address
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Address Line | 4700 GREENFIELD RD LOWER LEVEL
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City | DEARBORN
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State | MI
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Zip | 48126-4124
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Country | US
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Telephone | 313-624-9470
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. FAISAL RIAZ AHMAD
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Credential |
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Telephone | 313-624-9470
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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 | MI
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