MEDICARE: MAX REHAB PHYSICAL THERAPY, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261Q00000X	Clinic/Center	5501011866	MI

General Provider Information

NPI Number	:	1124325774
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MAX REHAB PHYSICAL THERAPY, LLC

Provider Business Mailing Address
First Line	:	28051 DEQUINDRE RD
Second Line	:
City	:	MADISON HEIGHTS
State	:	MI
Zip	:	48071-3016
Country	:	US
Telephone Number	:	248-629-4011
Fax Number	:	248-629-4010

Provider Business Practice Location Address
First Line	:	28051 DEQUINDRE RD
Second Line	:
City	:	MADISON HEIGHTS
State	:	MI
Zip	:	48071-3016
Country	:	US
Telephone Number	:	248-629-4011
Fax Number	:	248-629-4010

Authorized Official
Title or Position	:	CEO/ADMINISTRATOR
Name	:	MR. JOSEPH LABIB
Credential	:	RPT, DPT
Telephone Number	:	248-629-4011

Provider Enumeration Date	:	02/17/2011
Last Update Date	:	06/11/2020

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