Provider Demographics
NPI:1780029074
Name:EZ REST RE-HAB CENTER INC.
Entity Type:Organization
Organization Name:EZ REST RE-HAB CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:WOLODKOWICZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-275-5221
Mailing Address - Street 1:25932 DEQUINDRE RD STE C
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48091-1071
Mailing Address - Country:US
Mailing Address - Phone:248-275-5221
Mailing Address - Fax:586-486-5552
Practice Address - Street 1:25932 DEQUINDRE RD STE C
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48091-1071
Practice Address - Country:US
Practice Address - Phone:248-275-5221
Practice Address - Fax:586-486-5552
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-01
Last Update Date:2014-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI207R00000X
MI4301039079208VP0014X
MI5501005051225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty