Provider Demographics
NPI:1275207136
Name:A ONE REHAB LIMITED LLC
Entity Type:Organization
Organization Name:A ONE REHAB LIMITED LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RAJA
Authorized Official - Middle Name:R
Authorized Official - Last Name:GOVINDARAJALU
Authorized Official - Suffix:
Authorized Official - Credentials:RPT
Authorized Official - Phone:248-722-1156
Mailing Address - Street 1:808 LIVERNOIS ST STE 100
Mailing Address - Street 2:
Mailing Address - City:FERNDALE
Mailing Address - State:MI
Mailing Address - Zip Code:48220-2309
Mailing Address - Country:US
Mailing Address - Phone:248-722-1156
Mailing Address - Fax:
Practice Address - Street 1:808 LIVERNOIS ST STE 100
Practice Address - Street 2:
Practice Address - City:FERNDALE
Practice Address - State:MI
Practice Address - Zip Code:48220-2309
Practice Address - Country:US
Practice Address - Phone:248-722-1156
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-04
Last Update Date:2021-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIPENDINGMedicaid