MEDICARE: CLEGG, GUEST & BRABANT PHYSICAL REHABILITATION, 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	225100000X	Physical Therapist	5501002831	MI
2	225X00000X	Occupational Therapist	5201000760	MI
3	225100000X	Physical Therapist	5501002893	MI
4	225100000X	Physical Therapist	5501001771	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	30462	OTHER		BCBS

General Provider Information

NPI Number	:	1841226412
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CLEGG, GUEST & BRABANT PHYSICAL REHABILITATION, P.C.

Provider Business Mailing Address
First Line	:	35413 SCHOENHERR RD
Second Line	:
City	:	STERLING HEIGHTS
State	:	MI
Zip	:	48312-4258
Country	:	US
Telephone Number	:	586-978-7900
Fax Number	:	586-978-7710

Provider Business Practice Location Address
First Line	:	35413 SCHOENHERR RD
Second Line	:
City	:	STERLING HEIGHTS
State	:	MI
Zip	:	48312-4258
Country	:	US
Telephone Number	:	586-978-7900
Fax Number	:	586-978-7710

Authorized Official
Title or Position	:	OWNER/ADMIN
Name	:	STANLEY J GUEST
Credential	:	PT, FAAOMPT, OCS
Telephone Number	:	586-978-7900

Provider Enumeration Date	:	06/24/2006
Last Update Date	:	10/07/2020

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Directions to “CLEGG, GUEST & BRABANT PHYSICAL REHABILITATION, P.C. ” Practice Location

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