Provider Demographics
NPI:1164912945
Name:PREVENT REHABILITATION PLLC
Entity Type:Organization
Organization Name:PREVENT REHABILITATION PLLC
Other - Org Name:PREVENT PHYSICAL THERAPY & WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:S
Authorized Official - Last Name:OROW
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:248-862-6407
Mailing Address - Street 1:6621 W MAPLE RD
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322-3004
Mailing Address - Country:US
Mailing Address - Phone:248-227-5333
Mailing Address - Fax:248-598-2413
Practice Address - Street 1:6621 W MAPLE RD
Practice Address - Street 2:
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48322-3004
Practice Address - Country:US
Practice Address - Phone:248-227-5333
Practice Address - Fax:248-598-2413
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-16
Last Update Date:2018-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501012820225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty