=====================================================
General NPI Number Information
=====================================================
NPI Number | 1174562037
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TOTAL PHYSICAL THERAPY & REHABILITATION,INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/06/2006
-----------------------------------------------------
Last Update Date | 11/02/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 811 OAKWOOD STE 102
-----------------------------------------------------
City | ROCHESTER
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48307
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 248-656-1985
-----------------------------------------------------
Fax | 248-656-3729
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 811 OAKWOOD STE 102
-----------------------------------------------------
City | ROCHESTER
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48307
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 248-656-1985
-----------------------------------------------------
Fax | 248-656-3729
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER ADMINSITRATOR
-----------------------------------------------------
Name | MR. KYOUNG HONG UH
-----------------------------------------------------
Credential | PT
-----------------------------------------------------
Telephone | 248-656-1985
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QR0401X
-----------------------------------------------------
Taxonomy Name | Comprehensive Outpatient Rehabilitation Facility (CORF)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------