Provider Demographics
NPI:1134492499
Name:PHOENIX REHABILITATION SERVICE
Entity Type:Organization
Organization Name:PHOENIX REHABILITATION SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ATEF
Authorized Official - Middle Name:
Authorized Official - Last Name:HAMAD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-525-1113
Mailing Address - Street 1:624 E 9 MILE RD
Mailing Address - Street 2:
Mailing Address - City:HAZEL PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48030-1842
Mailing Address - Country:US
Mailing Address - Phone:313-525-5554
Mailing Address - Fax:
Practice Address - Street 1:624 E 9 MILE RD
Practice Address - Street 2:
Practice Address - City:HAZEL PARK
Practice Address - State:MI
Practice Address - Zip Code:48030-1842
Practice Address - Country:US
Practice Address - Phone:313-525-5554
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-17
Last Update Date:2017-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy