Provider Demographics
NPI:1235407677
Name:ST MARY REHABILITATION SERVICES LLC
Entity Type:Organization
Organization Name:ST MARY REHABILITATION SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMIR
Authorized Official - Middle Name:
Authorized Official - Last Name:NAWAR
Authorized Official - Suffix:
Authorized Official - Credentials:PT, PES,CI
Authorized Official - Phone:586-977-0001
Mailing Address - Street 1:1580 CRIMSON DR
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48083-5505
Mailing Address - Country:US
Mailing Address - Phone:313-982-0002
Mailing Address - Fax:313-982-0004
Practice Address - Street 1:18311 W WARREN AVE
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48228-3428
Practice Address - Country:US
Practice Address - Phone:313-982-0002
Practice Address - Fax:313-982-0004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-13
Last Update Date:2011-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty