Provider Demographics
NPI:1790455046
Name:TEAM REHABILITATION SERVICES, LLC
Entity Type:Organization
Organization Name:TEAM REHABILITATION SERVICES, LLC
Other - Org Name:TEAM REHABILITATION - IN
Other - Org Type:Other Name
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:NICHOLAS
Authorized Official - Last Name:WEBER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-282-7757
Mailing Address - Street 1:33900 HARPER AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:CLINTON TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48035-4258
Mailing Address - Country:US
Mailing Address - Phone:586-350-2644
Mailing Address - Fax:
Practice Address - Street 1:613 W LINCOLN RD
Practice Address - Street 2:
Practice Address - City:KOKOMO
Practice Address - State:IN
Practice Address - Zip Code:46902-3460
Practice Address - Country:US
Practice Address - Phone:765-416-6630
Practice Address - Fax:765-416-6629
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TEAM REHABILITATION SERVICES, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-09-17
Last Update Date:2022-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty