Provider Demographics
NPI:1235488230
Name:ACTIVE REHAB OF MICHIGAN
Entity Type:Organization
Organization Name:ACTIVE REHAB OF MICHIGAN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:ELI
Authorized Official - Middle Name:
Authorized Official - Last Name:KABBAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-269-2700
Mailing Address - Street 1:128 W HURON AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:BAD AXE
Mailing Address - State:MI
Mailing Address - Zip Code:48413-1101
Mailing Address - Country:US
Mailing Address - Phone:989-269-2700
Mailing Address - Fax:989-269-2705
Practice Address - Street 1:128 W HURON AVE
Practice Address - Street 2:SUITE B
Practice Address - City:BAD AXE
Practice Address - State:MI
Practice Address - Zip Code:48413-1101
Practice Address - Country:US
Practice Address - Phone:989-269-2700
Practice Address - Fax:989-269-2705
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-05
Last Update Date:2012-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501005670225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty