Provider Demographics
NPI:1073961249
Name:JC REHABILITATION & FITNESS, LLC
Entity Type:Organization
Organization Name:JC REHABILITATION & FITNESS, LLC
Other - Org Name:JC PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:KASHAT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-519-3084
Mailing Address - Street 1:2338 AUBURN RD
Mailing Address - Street 2:
Mailing Address - City:SHELBY TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48317-3809
Mailing Address - Country:US
Mailing Address - Phone:586-580-3929
Mailing Address - Fax:586-580-3785
Practice Address - Street 1:38904 DEQUINDRE RD
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48310-2890
Practice Address - Country:US
Practice Address - Phone:586-580-3929
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-29
Last Update Date:2019-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy