MEDICARE: REHAB LAB 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
2	261QP2000X	Physical Therapy Clinic/Center

General Provider Information

NPI Number	:	1649011743
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REHAB LAB LLC

Provider Business Mailing Address
First Line	:	53772 REGENCY HILLS CT
Second Line	:
City	:	SHELBY TOWNSHIP
State	:	MI
Zip	:	48316-2047
Country	:	US
Telephone Number	:	248-939-0052
Fax Number	:

Provider Business Practice Location Address
First Line	:	884 S ROCHESTER RD
Second Line	:
City	:	ROCHESTER HILLS
State	:	MI
Zip	:	48307-2740
Country	:	US
Telephone Number	:	248-781-4374
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MR. DANNY AZZOW
Credential	:
Telephone Number	:	248-939-0052

Provider Enumeration Date	:	06/03/2024
Last Update Date	:	07/05/2024

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