Provider Demographics
NPI:1760574800
Name:INTERNATIONAL PHYSICAL THERAPY & REHABILITATION, I
Entity Type:Organization
Organization Name:INTERNATIONAL PHYSICAL THERAPY & REHABILITATION, I
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SOHAIL
Authorized Official - Middle Name:
Authorized Official - Last Name:KHAN
Authorized Official - Suffix:
Authorized Official - Credentials:PTA
Authorized Official - Phone:586-698-2168
Mailing Address - Street 1:39393 VAN DYKE AVE
Mailing Address - Street 2:SUITE 103-A
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48313-4635
Mailing Address - Country:US
Mailing Address - Phone:586-698-2168
Mailing Address - Fax:586-698-2173
Practice Address - Street 1:39393 VAN DYKE AVE
Practice Address - Street 2:SUITE 103-A
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48313-4635
Practice Address - Country:US
Practice Address - Phone:586-698-2168
Practice Address - Fax:586-698-2173
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2016-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation PractitionerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI236797Medicare Oscar/Certification