Provider Demographics
NPI:1417079500
Name:UMA REHABILITATION AND PHYSICAL THERAPY CENTER, INC.
Entity Type:Organization
Organization Name:UMA REHABILITATION AND PHYSICAL THERAPY CENTER, INC.
Other - Org Name:PREMIER PHYSICAL THERAPY & REHABILITATION, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:HINA
Authorized Official - Middle Name:TAZEEN
Authorized Official - Last Name:QAZI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-512-8009
Mailing Address - Street 1:30551 STEPHENSON HWY
Mailing Address - Street 2:SUITE B
Mailing Address - City:MADISON HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48071
Mailing Address - Country:US
Mailing Address - Phone:248-632-1155
Mailing Address - Fax:248-632-1165
Practice Address - Street 1:30551 STEPHENSON HWY STE B
Practice Address - Street 2:
Practice Address - City:MADISON HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48071-1645
Practice Address - Country:US
Practice Address - Phone:248-632-1155
Practice Address - Fax:248-632-1165
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI236843Medicare ID - Type UnspecifiedMEDICARE PROVIDER ID #