Provider Demographics
NPI:1417990359
Name:PROFESSIONAL REHAB CARE, P.C.
Entity Type:Organization
Organization Name:PROFESSIONAL REHAB CARE, P.C.
Other - Org Name:UNITED PHYSICAL THERAPY AND REHABILITATION, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ZAKA
Authorized Official - Middle Name:
Authorized Official - Last Name:ULLAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-233-6832
Mailing Address - Street 1:28440 SOUTHFIELD RD
Mailing Address - Street 2:LATHRUP VILLAGE
Mailing Address - City:LATHRUP VILLAGE
Mailing Address - State:MI
Mailing Address - Zip Code:48076-2820
Mailing Address - Country:US
Mailing Address - Phone:248-462-7669
Mailing Address - Fax:
Practice Address - Street 1:28440 SOUTHFIELD RD
Practice Address - Street 2:LATHRUP VILLAGE
Practice Address - City:LATHRUP VILLAGE
Practice Address - State:MI
Practice Address - Zip Code:48076-2820
Practice Address - Country:US
Practice Address - Phone:248-462-7669
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-14
Last Update Date:2016-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI236809Medicare Oscar/Certification