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General NPI Number Information
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NPI Number | 1760661631
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Entity Type | Organization
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Legal Business Name | PROFESSIONAL QUALITY REHAB SERVICES,INC
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Dates
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Enumeration Date | 10/29/2007
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Last Update Date | 01/02/2024
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Provider Practice Location Address
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Address Line | 7460 DRY CREEK DR APT 2A
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City | GRAND BLANC
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State | MI
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Zip | 48439-6313
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Country | US
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Telephone | 810-265-3882
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Fax | 810-963-0560
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Provider Business Mailing Address
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Address Line | 7460 DRY CREEK DR APT 2A
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City | GRAND BLANC
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State | MI
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Zip | 48439-6313
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Country | US
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Telephone | 810-265-3882
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Fax | 810-963-0560
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. MADHAVAN KRISHNAMOORTHY
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Credential | PT
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Telephone | 810-230-0891
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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 | 5501007308
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License Number State | MI
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