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General NPI Number Information
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NPI Number | 1679657142
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Entity Type | Organization
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Legal Business Name | STANDARD REHABILITATION GROUP INC
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Dates
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Enumeration Date | 10/24/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 15785 LIVERNOIS AVE
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City | DETROIT
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State | MI
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Zip | 48238-1367
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Country | US
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Telephone | 313-934-2623
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Fax | 313-934-2656
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Provider Business Mailing Address
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Address Line | 25368 CAROLLTON DR
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City | FARMINGTON HILLS
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State | MI
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Zip | 48335-1309
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Country | US
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Telephone | 248-821-4951
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Fax | 248-888-0467
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Authorized Official
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Title or Position | PRESIDENT
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Name | MONSURU BELLO
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Credential | RPT
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Telephone | 313-934-2623
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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 | 5501005574
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License Number State | MI
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