Provider Demographics
NPI:1417091950
Name:ULTIMATE REHABILITATION SERVICES INC.
Entity Type:Organization
Organization Name:ULTIMATE REHABILITATION SERVICES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:OLUGESIN
Authorized Official - Middle Name:
Authorized Official - Last Name:AKANDE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:313-341-4910
Mailing Address - Street 1:18663 LIVERNOIS AVE
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48221-4212
Mailing Address - Country:US
Mailing Address - Phone:313-341-4910
Mailing Address - Fax:313-341-4916
Practice Address - Street 1:18663 LIVERNOIS AVE
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48221-4212
Practice Address - Country:US
Practice Address - Phone:313-341-4910
Practice Address - Fax:313-341-4916
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOM80290Medicare ID - Type Unspecified