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General NPI Number Information
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NPI Number | 1760351290
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Entity Type | Organization
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Legal Business Name | PHYSICAL REHAB SERVICE LLC
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Dates
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Enumeration Date | 11/03/2025
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Last Update Date | 11/03/2025
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Provider Practice Location Address
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Address Line | 21700 GREENFIELD RD STE 213
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City | OAK PARK
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State | MI
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Zip | 48237-2888
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Country | US
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Telephone | 248-677-3261
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Fax |
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Provider Business Mailing Address
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Address Line | 21700 GREENFIELD RD STE 213
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City | OAK PARK
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State | MI
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Zip | 48237-2888
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Country | US
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Telephone | 248-677-3261
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KANIYA FOSTER
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Credential |
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Telephone | 313-613-7271
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2081P2900X
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Taxonomy Name | Pain Medicine (Physical Medicine & Rehabilitation) Physician
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License Number |
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License Number State |
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