Provider Demographics
NPI:1083380729
Name:PARC REHABILITATION, LLC
Entity Type:Organization
Organization Name:PARC REHABILITATION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GASSO
Authorized Official - Suffix:
Authorized Official - Credentials:OT
Authorized Official - Phone:248-915-8592
Mailing Address - Street 1:33060 NORTHWESTERN HWY STE 210A
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322-3695
Mailing Address - Country:US
Mailing Address - Phone:248-915-8592
Mailing Address - Fax:
Practice Address - Street 1:33060 NORTHWESTERN HWY STE 210A
Practice Address - Street 2:
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48322-3695
Practice Address - Country:US
Practice Address - Phone:248-915-8592
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-23
Last Update Date:2021-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty