Provider Demographics
NPI:1366692584
Name:ACCESS PHYSICAL THERAPY & REHAB
Entity Type:Organization
Organization Name:ACCESS PHYSICAL THERAPY & REHAB
Other - Org Name:ACCESS PHYSICAL THERAPY & REHAB, LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:GIGI
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:586-344-6353
Mailing Address - Street 1:15700 PROVIDENCE DR APT 400
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-3127
Mailing Address - Country:US
Mailing Address - Phone:586-344-6353
Mailing Address - Fax:
Practice Address - Street 1:2710 S ROCHESTER RD
Practice Address - Street 2:SUITE -C
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48307-4598
Practice Address - Country:US
Practice Address - Phone:248-844-9920
Practice Address - Fax:248-844-9920
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-24
Last Update Date:2017-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIB96203225100000X
MI235Z00000X, 251B00000X, 251C00000X, 343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
No251B00000XAgenciesCase Management
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)Group - Single Specialty