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General NPI Number Information
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NPI Number | 1992578231
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Entity Type | Organization
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Legal Business Name | INTERSTATE REHAB
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Dates
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Enumeration Date | 10/30/2023
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Last Update Date | 10/30/2023
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Provider Practice Location Address
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Address Line | 1000 JOHN R RD STE 114
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City | TROY
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State | MI
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Zip | 48083-4317
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Country | US
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Telephone | 248-850-8745
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Fax | 248-843-0044
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Provider Business Mailing Address
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Address Line | 1000 JOHN R RD STE 114
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City | TROY
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State | MI
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Zip | 48083-4317
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Country | US
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Telephone | 248-850-8745
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Fax | 248-843-0044
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Authorized Official
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Title or Position | PRESIDENT
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Name | GERARDO B. CARBONELL
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Credential | DPT
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Telephone | 586-530-7114
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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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Taxonomy #2
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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