MEDICARE: LORDS PHYSICAL THERAPY AND REHAB SERVICES

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

General Provider Information

NPI Number	:	1831275270
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LORDS PHYSICAL THERAPY AND REHAB SERVICES

Provider Business Mailing Address
First Line	:	1920 JUNCTION ST
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48209-2168
Country	:	US
Telephone Number	:	313-739-3505
Fax Number	:

Provider Business Practice Location Address
First Line	:	1920 JUNCTION ST
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48209-2168
Country	:	US
Telephone Number	:	313-739-3505
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	SHAMNATH A RAHIM
Credential	:	RPT
Telephone Number	:	313-297-3233

Provider Enumeration Date	:	10/28/2006
Last Update Date	:	08/22/2020

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