MEDICARE: PHASE ONE REHAB, 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	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1326311135
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHASE ONE REHAB, LLC

Provider Business Mailing Address
First Line	:	29155 NORTHWESTERN HWY
Second Line	:	SUITE 727
City	:	SOUTHFIELD
State	:	MI
Zip	:	48034-1011
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	34119 W 12 MILE RD STE 160
Second Line	:
City	:	FARMINGTON HILLS
State	:	MI
Zip	:	48331-3371
Country	:	US
Telephone Number	:	248-733-5022
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	PATRICK DAVIDSON
Credential	:
Telephone Number	:	248-626-3100

Provider Enumeration Date	:	02/10/2012
Last Update Date	:	05/05/2025

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