Provider Demographics
NPI:1760661631
Name:PROFESSIONAL QUALITY REHAB SERVICES,INC
Entity Type:Organization
Organization Name:PROFESSIONAL QUALITY REHAB SERVICES,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MADHAVAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KRISHNAMOORTHY
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:810-230-0891
Mailing Address - Street 1:7460 DRY CREEK DR APT 2A
Mailing Address - Street 2:
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48439-6313
Mailing Address - Country:US
Mailing Address - Phone:810-265-3882
Mailing Address - Fax:810-963-0560
Practice Address - Street 1:7460 DRY CREEK DR APT 2A
Practice Address - Street 2:
Practice Address - City:GRAND BLANC
Practice Address - State:MI
Practice Address - Zip Code:48439-6313
Practice Address - Country:US
Practice Address - Phone:810-265-3882
Practice Address - Fax:810-963-0560
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-29
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501007308225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MION38900Medicare PIN