Provider Demographics
NPI:1508914797
Name:MERCY PHYSICAL THERAPY AND REHABILITATION
Entity Type:Organization
Organization Name:MERCY PHYSICAL THERAPY AND REHABILITATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:GAFFAR
Authorized Official - Middle Name:
Authorized Official - Last Name:KHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:586-977-7833
Mailing Address - Street 1:31690 HOOVER RD
Mailing Address - Street 2:SUITE #101
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48093-7653
Mailing Address - Country:US
Mailing Address - Phone:586-977-7833
Mailing Address - Fax:586-977-7831
Practice Address - Street 1:31690 HOOVER RD
Practice Address - Street 2:SUITE #101
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48093-7653
Practice Address - Country:US
Practice Address - Phone:586-977-7833
Practice Address - Fax:586-977-7831
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation PractitionerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI236776Medicare ID - Type UnspecifiedMERCY P.T REHAB.