MEDICARE: MICHIGAN PHYSICAL THERAPY AND 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	261QP2000X	Physical Therapy Clinic/Center		MI

General Provider Information

NPI Number	:	1538576475
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MICHIGAN PHYSICAL THERAPY AND REHAB, LLC.

Provider Business Mailing Address
First Line	:	37522 DEQUINDRE RD STE C
Second Line	:
City	:	STERLING HEIGHTS
State	:	MI
Zip	:	48310-3511
Country	:	US
Telephone Number	:	586-944-9908
Fax Number	:	586-698-2173

Provider Business Practice Location Address
First Line	:	37522 DEQUINDRE RD STE C
Second Line	:
City	:	STERLING HEIGHTS
State	:	MI
Zip	:	48310-3511
Country	:	US
Telephone Number	:	586-944-9908
Fax Number	:	586-698-2173

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MR. SOHAIL KHAN
Credential	:
Telephone Number	:	586-944-9908

Provider Enumeration Date	:	07/11/2014
Last Update Date	:	07/14/2014

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