MEDICARE: APOLLO REHAB SERVICES 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	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1184359325
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	APOLLO REHAB SERVICES LLC

Provider Business Mailing Address
First Line	:	1595 BEACHWOOD DR
Second Line	:
City	:	WALLED LAKE
State	:	MI
Zip	:	48390-5881
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	12855 DIX TOLEDO RD
Second Line	:
City	:	SOUTHGATE
State	:	MI
Zip	:	48195-1744
Country	:	US
Telephone Number	:	586-219-1290
Fax Number	:

Authorized Official
Title or Position	:	OWNER, CEO
Name	:	MR. HARISH SATHRI JEDEDIAH
Credential	:	RPT
Telephone Number	:	586-219-1290

Provider Enumeration Date	:	07/21/2022
Last Update Date	:	07/06/2023

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