Provider Demographics
NPI:1225208937
Name:MICHIGAN REHABILITATION SPECIALISTS OF ANN ARBOR LLC
Entity Type:Organization
Organization Name:MICHIGAN REHABILITATION SPECIALISTS OF ANN ARBOR LLC
Other - Org Name:MICHIGAN REHABILITATION SPECIALISTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CO-OWNER / PT
Authorized Official - Prefix:
Authorized Official - First Name:RODNEY
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:GOBLE
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:810-231-6904
Mailing Address - Street 1:3520 GREEN CT
Mailing Address - Street 2:STE 165
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48105-1566
Mailing Address - Country:US
Mailing Address - Phone:734-585-3313
Mailing Address - Fax:
Practice Address - Street 1:3520 GREEN CT
Practice Address - Street 2:STE 165
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48105-1566
Practice Address - Country:US
Practice Address - Phone:734-585-3313
Practice Address - Fax:734-585-3315
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-10
Last Update Date:2012-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty