Provider Demographics
NPI:1598219180
Name:PROFESSIONAL CARE REHAB LLC
Entity Type:Organization
Organization Name:PROFESSIONAL CARE REHAB LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RPT
Authorized Official - Prefix:MRS
Authorized Official - First Name:THIRUPATHI
Authorized Official - Middle Name:REDDY
Authorized Official - Last Name:ALLALA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-476-1780
Mailing Address - Street 1:2155 N LOVINGTON DR APT 207
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48083-5804
Mailing Address - Country:US
Mailing Address - Phone:813-476-1780
Mailing Address - Fax:
Practice Address - Street 1:17707 FENKELL ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48227-1513
Practice Address - Country:US
Practice Address - Phone:813-476-1780
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-11
Last Update Date:2016-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501014432261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy