Provider Demographics
NPI:1124226519
Name:MODERN PHYSICAL THERAPY & REHAB, INC.
Entity Type:Organization
Organization Name:MODERN PHYSICAL THERAPY & REHAB, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:FAISAL
Authorized Official - Middle Name:RIAZ
Authorized Official - Last Name:AHMAD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-624-9470
Mailing Address - Street 1:4700 GREENFIELD RD
Mailing Address - Street 2:LOWER LEVEL
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48126-4124
Mailing Address - Country:US
Mailing Address - Phone:313-624-9470
Mailing Address - Fax:
Practice Address - Street 1:4700 GREENFIELD RD
Practice Address - Street 2:LOWER LEVEL
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126-4124
Practice Address - Country:US
Practice Address - Phone:313-624-9470
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0N81470Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER