Provider Demographics
NPI:1669479564
Name:TOTAL CARE PHYSICAL THERAPY & REHABILITATION, INC
Entity Type:Organization
Organization Name:TOTAL CARE PHYSICAL THERAPY & REHABILITATION, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ALTERNATE ADMINISTRATOR, OT
Authorized Official - Prefix:MR
Authorized Official - First Name:VIJAY
Authorized Official - Middle Name:
Authorized Official - Last Name:MISHRA
Authorized Official - Suffix:
Authorized Official - Credentials:OT
Authorized Official - Phone:586-872-5133
Mailing Address - Street 1:17950 WOODWARD AVE
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48203-2260
Mailing Address - Country:US
Mailing Address - Phone:313-865-5200
Mailing Address - Fax:313-865-5300
Practice Address - Street 1:17950 WOODWARD AVE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48203-2260
Practice Address - Country:US
Practice Address - Phone:313-865-5200
Practice Address - Fax:313-865-5300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP-63118OtherBLUE CARE NETWORK
MIP-236731OtherHAP
MA30695OtherBCBS OF MICHIGAN
MA5274758OtherAETNA
MI236731Medicare ID - Type Unspecified