Provider Demographics
NPI:1003210378
Name:ORTHOPEDIC PHYSICAL THERAPY AND REHABILITATION LLC
Entity Type:Organization
Organization Name:ORTHOPEDIC PHYSICAL THERAPY AND REHABILITATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMIN
Authorized Official - Prefix:MR
Authorized Official - First Name:NAJM
Authorized Official - Middle Name:UL
Authorized Official - Last Name:HASSAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-268-3748
Mailing Address - Street 1:27253 VAN DYKE AVE
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48093-2858
Mailing Address - Country:US
Mailing Address - Phone:586-459-5692
Mailing Address - Fax:586-459-5695
Practice Address - Street 1:27253 VAN DYKE AVE
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48093-2858
Practice Address - Country:US
Practice Address - Phone:586-459-5692
Practice Address - Fax:586-459-5695
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-15
Last Update Date:2020-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy