Provider Demographics
NPI:1407232739
Name:TRI-CARE PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:TRI-CARE PHYSICAL THERAPY LLC
Other - Org Name:TRI-CARE REHAB CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ADEEB
Authorized Official - Middle Name:NAGIB
Authorized Official - Last Name:SOBH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-334-1116
Mailing Address - Street 1:24100 W. WARREN AVE
Mailing Address - Street 2:
Mailing Address - City:DEARBORN HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48127
Mailing Address - Country:US
Mailing Address - Phone:313-434-6000
Mailing Address - Fax:313-427-8166
Practice Address - Street 1:24100 W. WARREN AVE
Practice Address - Street 2:
Practice Address - City:DEARBORN HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48127
Practice Address - Country:US
Practice Address - Phone:313-434-6000
Practice Address - Fax:313-427-8166
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-10
Last Update Date:2022-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy