MEDICARE: PREFERRED REHAB CARE INC

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
2	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1649472960
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PREFERRED REHAB CARE INC

Provider Business Mailing Address
First Line	:	4020 VENOY RD STE 700
Second Line	:
City	:	WAYNE
State	:	MI
Zip	:	48184-1891
Country	:	US
Telephone Number	:	734-727-1309
Fax Number	:	734-727-1319

Provider Business Practice Location Address
First Line	:	4020 VENOY RD STE 700
Second Line	:
City	:	WAYNE
State	:	MI
Zip	:	48184-1891
Country	:	US
Telephone Number	:	734-727-1309
Fax Number	:	734-727-1319

Authorized Official
Title or Position	:	PRESIDENT/ADMINISTRATOR
Name	:	RAVI B KUKKALLI
Credential	:	PT
Telephone Number	:	734-727-1309

Provider Enumeration Date	:	05/31/2007
Last Update Date	:	10/15/2024

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