Provider Demographics
NPI:1265470728
Name:TEAM REHABILITATION SG, LLC
Entity Type:Organization
Organization Name:TEAM REHABILITATION SG, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:DELCOMYN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:734-285-0100
Mailing Address - Street 1:33900 HARPER AVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48035-4258
Mailing Address - Country:US
Mailing Address - Phone:586-416-9100
Mailing Address - Fax:586-416-9103
Practice Address - Street 1:15400 NORTHLINE RD
Practice Address - Street 2:
Practice Address - City:SOUTHGATE
Practice Address - State:MI
Practice Address - Zip Code:48195-2333
Practice Address - Country:US
Practice Address - Phone:734-285-0100
Practice Address - Fax:734-285-0101
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TEAM REHABILITATION SERVICES LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-04
Last Update Date:2016-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0P13550Medicare PIN