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General NPI Number Information
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NPI Number | 1154698439
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Entity Type | Organization
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Legal Business Name | ADVANTAGE PROFESSIONAL REHAB. SERVICES LTD
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Dates
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Enumeration Date | 11/30/2011
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Last Update Date | 11/30/2011
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Provider Practice Location Address
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Address Line | 23411 JOHN R RD
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City | HAZEL PARK
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State | MI
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Zip | 48030-1404
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Country | US
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Telephone | 248-544-4181
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Fax |
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Provider Business Mailing Address
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Address Line | 6701 STONEBRIDGE CT
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City | WEST BLOOMFIELD
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State | MI
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Zip | 48322-3268
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Country | US
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Telephone | 248-240-4111
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MUHAMMAD SAEED TARIQ
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Credential | RPT
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Telephone | 248-240-4111
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number | 5305035066
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License Number State | MI
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