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General NPI Number Information
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NPI Number | 1134556103
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Entity Type | Organization
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Legal Business Name | HEALTH SOURCE REHAB, LLC
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Dates
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Enumeration Date | 10/04/2013
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Last Update Date | 10/04/2013
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Provider Practice Location Address
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Address Line | 4100 E 11 MILE RD
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City | WARREN
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State | MI
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Zip | 48091-1192
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Country | US
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Telephone | 586-757-2440
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Fax | 586-757-2441
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Provider Business Mailing Address
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Address Line | 4100 E 11 MILE RD
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City | WARREN
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State | MI
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Zip | 48091-1192
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Country | US
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Telephone | 586-757-2440
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Fax | 586-757-2441
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Authorized Official
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Title or Position | DIRECTOR
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Name | MR. AUGUSTO DAYCO
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Credential |
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Telephone | 586-757-2440
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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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