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General NPI Number Information
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NPI Number | 1255867222
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Entity Type | Organization
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Legal Business Name | DYNAMIC REHAB, LLC
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Dates
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Enumeration Date | 05/11/2017
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Last Update Date | 05/11/2017
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Provider Practice Location Address
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Address Line | 15700 PROVIDENCE DR 400
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City | SOUTHFIELD
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State | MI
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Zip | 48075-3144
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Country | US
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Telephone | 248-233-6467
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Fax | 248-415-6289
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Provider Business Mailing Address
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Address Line | 15700 PROVIDENCE DR 400
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City | SOUTHFIELD
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State | MI
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Zip | 48075-3144
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Country | US
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Telephone | 248-233-6467
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Fax | 248-415-6289
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Authorized Official
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Title or Position | ADMIN
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Name | SUJIT JOHN
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Credential |
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Telephone | 248-233-6467
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number |
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State | MI
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Taxonomy #4
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Taxonomy Code | 347C00000X
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Taxonomy Name | Private Vehicle
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License Number |
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License Number State | MI
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Taxonomy #5
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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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