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General NPI Number Information
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NPI Number | 1346294287
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Entity Type | Organization
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Legal Business Name | MONROEREHABCONNECTION LLC
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Dates
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Enumeration Date | 05/22/2006
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Last Update Date | 04/04/2008
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Provider Practice Location Address
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Address Line | 1038 N MONROE ST
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City | MONROE
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State | MI
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Zip | 48162-3113
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Country | US
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Telephone | 734-242-0101
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Fax |
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Provider Business Mailing Address
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Address Line | 1038 N MONROE ST
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City | MONROE
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State | MI
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Zip | 48162-3113
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Country | US
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Telephone | 734-242-0101
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Fax |
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Authorized Official
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Title or Position | SINGLE MEMBEROWNER
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Name | MR. JAROSLAW ANDRZEJ LATALA
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Credential | PT
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Telephone | 734-242-0101
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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 | 5501004877
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License Number State | MI
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