MEDICARE: PROFESSIONAL REHAB CARE, P.C.

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	261QR0400X	Rehabilitation Clinic/Center

General Provider Information

NPI Number	:	1417990359
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROFESSIONAL REHAB CARE, P.C.

Provider Business Mailing Address
First Line	:	28440 SOUTHFIELD RD
Second Line	:	LATHRUP VILLAGE
City	:	LATHRUP VILLAGE
State	:	MI
Zip	:	48076-2820
Country	:	US
Telephone Number	:	248-462-7669
Fax Number	:

Provider Business Practice Location Address
First Line	:	28440 SOUTHFIELD RD
Second Line	:	LATHRUP VILLAGE
City	:	LATHRUP VILLAGE
State	:	MI
Zip	:	48076-2820
Country	:	US
Telephone Number	:	248-462-7669
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ZAKA ULLAH
Credential	:
Telephone Number	:	248-233-6832

Provider Enumeration Date	:	06/14/2006
Last Update Date	:	11/08/2016

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