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General NPI Number Information
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NPI Number | 1295258374
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Entity Type | Organization
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Legal Business Name | STAYFIT REHAB INC
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Dates
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Enumeration Date | 07/20/2017
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Last Update Date | 07/20/2017
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Provider Practice Location Address
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Address Line | 2191 SOUTH BLVD SUITE 203
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City | AUBURN HILLS
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State | MI
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Zip | 48326-4832
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Country | US
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Telephone | 248-334-9003
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Fax | 248-334-9334
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Provider Business Mailing Address
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Address Line | 2191 SOUTH BVLD STE 203
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City | AUBURN HILLS
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State | MI
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Zip | 48326
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Country | US
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Telephone | 248-334-9003
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Fax | 248-334-9334
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Authorized Official
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Title or Position | CO-OWNER
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Name | GANESHKUMAR SHANMUGASUNDARAM
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Credential | RPT
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Telephone | 248-334-9003
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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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Taxonomy #2
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Taxonomy Code | 261QR0400X
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Taxonomy Name | Rehabilitation Clinic/Center
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License Number |
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License Number State | MI
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