Provider Demographics
NPI:1336649458
Name:FAMILY MEDICAL REHAB LLC
Entity Type:Organization
Organization Name:FAMILY MEDICAL REHAB LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MISS
Authorized Official - First Name:SEANICE
Authorized Official - Middle Name:MONE
Authorized Official - Last Name:WADDELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-496-5773
Mailing Address - Street 1:21999 FARMINGTON RD
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:MI
Mailing Address - Zip Code:48336-4400
Mailing Address - Country:US
Mailing Address - Phone:248-496-5773
Mailing Address - Fax:
Practice Address - Street 1:21999 FARMINGTON RD
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:MI
Practice Address - Zip Code:48336-4400
Practice Address - Country:US
Practice Address - Phone:248-496-5773
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-15
Last Update Date:2018-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty