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General NPI Number Information
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NPI Number | 1336458876
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Entity Type | Organization
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Legal Business Name | DYNAMIC REHAB SERVICES INC
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Dates
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Enumeration Date | 10/01/2010
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Last Update Date | 10/01/2010
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Provider Practice Location Address
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Address Line | 16904 W WARREN AVE
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City | DETROIT
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State | MI
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Zip | 48228-3505
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Country | US
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Telephone | 313-945-5926
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Fax | 734-451-0603
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Provider Business Mailing Address
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Address Line | 34909 BUNKER HILL DR
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City | FARMINGTON HILLS
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State | MI
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Zip | 48331-3285
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Country | US
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Telephone | 248-727-4322
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Fax | 734-451-0603
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Authorized Official
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Title or Position | OWNER
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Name | MUSTAFA MANZUR
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Credential | RPT
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Telephone | 248-727-4322
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 5501006945
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License Number State | MI
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