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General NPI Number Information
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NPI Number | 1780711861
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Entity Type | Organization
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Legal Business Name | REHABILITATION SPECIALISTS OF LIVINGSTON COUNTY, INC.
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Dates
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Enumeration Date | 02/27/2007
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Last Update Date | 10/05/2007
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Provider Practice Location Address
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Address Line | 27427 SCHOENHERR RD SUITE 200
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City | WARREN
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State | MI
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Zip | 48088-4729
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Country | US
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Telephone | 586-757-9311
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Fax | 586-757-9401
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Provider Business Mailing Address
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Address Line | 27427 SCHOENHERR RD SUITE 200
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City | WARREN
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State | MI
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Zip | 48088-4729
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Country | US
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Telephone | 586-757-9311
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Fax | 586-757-9401
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Authorized Official
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Title or Position | CEO, PHYSICAL THERAPIST
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Name | MR. BRADLEY PUTVIN
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Credential | PT
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Telephone | 810-923-2361
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 00078683
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 5501001469
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License Number State | MI
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