Provider Demographics
NPI:1629390653
Name:ALETA REHAB SERVICES INC
Entity Type:Organization
Organization Name:ALETA REHAB SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ALVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:MATHEW
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:586-215-9493
Mailing Address - Street 1:10573 MORANG DR
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48224-1880
Mailing Address - Country:US
Mailing Address - Phone:586-215-9493
Mailing Address - Fax:586-731-6283
Practice Address - Street 1:10573 MORANG DR
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48224-1880
Practice Address - Country:US
Practice Address - Phone:586-215-9493
Practice Address - Fax:586-731-6283
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-18
Last Update Date:2010-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501011721225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PENDINGMedicare PIN