Provider Demographics
NPI:1508073826
Name:GREAT AMERICAN REHABILITATION AND PHYSICAL THERAPY CENTER, INC.
Entity Type:Organization
Organization Name:GREAT AMERICAN REHABILITATION AND PHYSICAL THERAPY CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:AKHTAR
Authorized Official - Middle Name:
Authorized Official - Last Name:QUAZI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-282-2201
Mailing Address - Street 1:3800 WOODWARD AVE
Mailing Address - Street 2:SUITE 510
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48201-2061
Mailing Address - Country:US
Mailing Address - Phone:734-282-2201
Mailing Address - Fax:734-282-2520
Practice Address - Street 1:3800 WOODWARD AVE
Practice Address - Street 2:SUITE 510
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-2061
Practice Address - Country:US
Practice Address - Phone:734-282-2201
Practice Address - Fax:734-282-2520
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI236848Medicare ID - Type Unspecified