MEDICARE: DOWNRIVER PHYSICAL THERAPY & REHABILITATION, 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	261QR0400X	Rehabilitation Clinic/Center

General Provider Information

NPI Number	:	1942259072
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DOWNRIVER PHYSICAL THERAPY & REHABILITATION, LLC

Provider Business Mailing Address
First Line	:	641 W 9 MILE RD
Second Line	:
City	:	FERNDALE
State	:	MI
Zip	:	48220-1779
Country	:	US
Telephone Number	:	248-987-6681
Fax Number	:	248-987-6682

Provider Business Practice Location Address
First Line	:	641 W 9 MILE RD
Second Line	:
City	:	FERNDALE
State	:	MI
Zip	:	48220-1779
Country	:	US
Telephone Number	:	248-399-5212
Fax Number	:	248-399-5256

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MAHMOOD AMIR
Credential	:
Telephone Number	:	248-987-6681

Provider Enumeration Date	:	05/08/2006
Last Update Date	:	08/03/2012

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