Provider Demographics
NPI:1275724502
Name:ST. MARY REHABILITATION SERVICES L.L.C
Entity Type:Organization
Organization Name:ST. MARY REHABILITATION SERVICES L.L.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:AMIR
Authorized Official - Middle Name:NAGY
Authorized Official - Last Name:NAWAR
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:586-486-3636
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:586-486-3636
Mailing Address - Fax:
Practice Address - Street 1:42621 GARFIELD RD STE 102
Practice Address - Street 2:
Practice Address - City:CLINTON TWP
Practice Address - State:MI
Practice Address - Zip Code:48038-5031
Practice Address - Country:US
Practice Address - Phone:586-838-2444
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-01
Last Update Date:2018-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QP2000X
MI332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0F37607OtherBCBS
MI6496720001OtherMEDICARE DME
MI6496720001OtherMEDICARE DME
MI6496720001Medicare NSC