Provider Demographics
NPI:1598962342
Name:ECLECTIC REHAB SPECIALISTS LLC
Entity Type:Organization
Organization Name:ECLECTIC REHAB SPECIALISTS LLC
Other - Org Name:ELEMENTS PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANN MARIE
Authorized Official - Middle Name:ABOBO
Authorized Official - Last Name:GARVIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:866-335-3255
Mailing Address - Street 1:4600 E 14 MILE RD
Mailing Address - Street 2:SUITE # 3
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48092-4369
Mailing Address - Country:US
Mailing Address - Phone:866-335-3255
Mailing Address - Fax:586-601-2500
Practice Address - Street 1:4600 E 14 MILE RD
Practice Address - Street 2:SUITE # 3
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48092-4369
Practice Address - Country:US
Practice Address - Phone:866-335-3255
Practice Address - Fax:586-601-2500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-27
Last Update Date:2008-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy