MEDICARE: EVOLVE REHAB PLLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	111N00000X	Chiropractor
2	2083P0011X	Undersea and Hyperbaric Medicine (Preventive Medicine) Physician
3	225700000X	Massage Therapist
4	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1407710999
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EVOLVE REHAB PLLC

Provider Business Mailing Address
First Line	:	6256 N TELEGRAPH RD
Second Line	:
City	:	DEARBORN HEIGHTS
State	:	MI
Zip	:	48127-3223
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6256 N TELEGRAPH RD
Second Line	:
City	:	DEARBORN HEIGHTS
State	:	MI
Zip	:	48127-3223
Country	:	US
Telephone Number	:	313-483-6002
Fax Number	:

Authorized Official
Title or Position	:	MEMBER
Name	:	MOHAMED RAYCHOUNI
Credential	:	DC
Telephone Number	:	313-483-6002

Provider Enumeration Date	:	12/10/2025
Last Update Date	:	12/10/2025

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