Provider Demographics
NPI:1093803595
Name:ADVANTAGE PHYSICAL THERAPY & REHABILITATION SERVICES, INC.
Entity Type:Organization
Organization Name:ADVANTAGE PHYSICAL THERAPY & REHABILITATION SERVICES, INC.
Other - Org Name:ADVANTAGE PHYSICAL THERAPY & REHABILITATION SERVICES, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DILIP
Authorized Official - Middle Name:K
Authorized Official - Last Name:DEY
Authorized Official - Suffix:
Authorized Official - Credentials:MHS, PT
Authorized Official - Phone:248-471-1602
Mailing Address - Street 1:19323 FARMINGTON RD
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48152-1404
Mailing Address - Country:US
Mailing Address - Phone:248-471-1602
Mailing Address - Fax:248-471-1674
Practice Address - Street 1:19323 FARMINGTON RD
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48152-1404
Practice Address - Country:US
Practice Address - Phone:248-471-1602
Practice Address - Fax:248-471-1674
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-10
Last Update Date:2008-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI30351OtherBLUE CROSS BLUE SHIELD
MI236787Medicare ID - Type UnspecifiedMEDICARE