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General NPI Number Information
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NPI Number | 1679963474
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Entity Type | Organization
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Legal Business Name | PRO ACTIVE REHAB, LLC
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Dates
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Enumeration Date | 01/31/2015
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Last Update Date | 01/31/2015
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Provider Practice Location Address
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Address Line | 24384 ELMHURST AVE
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City | FARMINGTON HILLS
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State | MI
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Zip | 48336-1931
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Country | US
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Telephone | 734-709-5361
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Fax |
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Provider Business Mailing Address
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Address Line | 23800 FORD RD STE 1
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City | DEARBORN HEIGHTS
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State | MI
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Zip | 48127-3200
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | BOARD MEMBER
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Name | ANKUR PATEL
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Credential |
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Telephone | 734-709-5361
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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 |
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License Number State |
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