Provider Demographics
NPI:1265652994
Name:LMT REHABILITATION ASSOCIATES,PC
Entity Type:Organization
Organization Name:LMT REHABILITATION ASSOCIATES,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING
Authorized Official - Prefix:MS
Authorized Official - First Name:EDNA
Authorized Official - Middle Name:L
Authorized Official - Last Name:BARLOW
Authorized Official - Suffix:
Authorized Official - Credentials:CMRS
Authorized Official - Phone:248-616-1170
Mailing Address - Street 1:30701 BARRINGTON ST STE 100
Mailing Address - Street 2:
Mailing Address - City:MADISON HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48071-5114
Mailing Address - Country:US
Mailing Address - Phone:248-616-1170
Mailing Address - Fax:248-589-9875
Practice Address - Street 1:15979 HALL ROAD
Practice Address - Street 2:SUITE 304
Practice Address - City:MACOMB
Practice Address - State:MI
Practice Address - Zip Code:48044-3904
Practice Address - Country:US
Practice Address - Phone:248-852-0860
Practice Address - Fax:248-589-9875
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-26
Last Update Date:2007-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081H0002XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationHospice and Palliative MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0F36058Medicare ID - Type Unspecified