Provider Demographics
NPI:1790381721
Name:PEDIATRIC REHAB SPECIALISTS
Entity Type:Organization
Organization Name:PEDIATRIC REHAB SPECIALISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:
Authorized Official - Last Name:ZAJAC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-797-2005
Mailing Address - Street 1:2381 LOST TREE WAY
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48304-1474
Mailing Address - Country:US
Mailing Address - Phone:248-797-2005
Mailing Address - Fax:
Practice Address - Street 1:2381 LOST TREE WAY
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48304-1474
Practice Address - Country:US
Practice Address - Phone:248-797-2005
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-06
Last Update Date:2021-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatricsGroup - Multi-Specialty