Provider Demographics
NPI:1114342433
Name:MICHIGAN REHAB SERVICES PROVIDER, INC.
Entity Type:Organization
Organization Name:MICHIGAN REHAB SERVICES PROVIDER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF BUSINESS OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:NILESHKUMAR
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:586-797-9775
Mailing Address - Street 1:1681 E AUBURN RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48307-5583
Mailing Address - Country:US
Mailing Address - Phone:586-797-9775
Mailing Address - Fax:
Practice Address - Street 1:1681 E AUBURN RD
Practice Address - Street 2:SUITE C
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48307-5583
Practice Address - Country:US
Practice Address - Phone:586-797-9775
Practice Address - Fax:586-797-9750
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-24
Last Update Date:2014-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501011761225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty