Provider Demographics
NPI:1699829119
Name:FUNCTIONAL REHAB SERVICES PC
Entity Type:Organization
Organization Name:FUNCTIONAL REHAB SERVICES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR PT
Authorized Official - Prefix:
Authorized Official - First Name:MUNIFA
Authorized Official - Middle Name:
Authorized Official - Last Name:MOHIBI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-921-1132
Mailing Address - Street 1:2575 MCLEOD DR N
Mailing Address - Street 2:SUITE B
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48604-2857
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2575 MCLEOD DR N
Practice Address - Street 2:SUITE B
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48604-2857
Practice Address - Country:US
Practice Address - Phone:989-921-1132
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2013-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI02952C320700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
23-6796Medicare ID - Type UnspecifiedMEDICARE NUMBER