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General NPI Number Information
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NPI Number | 1326327230
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Entity Type | Organization
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Legal Business Name | NORTHWESTERN REHABILITATION SERVICES. LLC
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Dates
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Enumeration Date | 08/09/2011
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Last Update Date | 08/09/2011
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Provider Practice Location Address
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Address Line | 23999 NORTHWESTERN HWY SUITE 105
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City | SOUTHFIELD
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State | MI
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Zip | 48075-2578
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Country | US
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Telephone | 248-352-4984
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Fax |
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Provider Business Mailing Address
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Address Line | 23999 NORTHWESTERN HWY SUITE 105
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City | SOUTHFIELD
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State | MI
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Zip | 48075-2578
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Country | US
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Telephone | 248-352-4984
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Fax |
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Authorized Official
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Title or Position | REGISTERED PHYSICAL THERAPIST
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Name | MR. JIMS T VARGHESE
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Credential | RPT
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Telephone | 248-352-4984
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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 | 5501014403
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License Number State | MI
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