Provider Demographics
NPI:1831476357
Name:MICHIGAN REHABILITATION SPECIALISTS OF PLYMOUTH INC
Entity Type:Organization
Organization Name:MICHIGAN REHABILITATION SPECIALISTS OF PLYMOUTH INC
Other - Org Name:MICHIGAN REHABILITATION SPECIALISTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:LINCOLN
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:810-231-6904
Mailing Address - Street 1:PO BOX 215
Mailing Address - Street 2:
Mailing Address - City:HAMBURG
Mailing Address - State:MI
Mailing Address - Zip Code:48139-0215
Mailing Address - Country:US
Mailing Address - Phone:810-231-6904
Mailing Address - Fax:810-360-4326
Practice Address - Street 1:44191 PLYMOUTH OAKS BLVD
Practice Address - Street 2:SUITE 600
Practice Address - City:PLYMOUTH
Practice Address - State:MI
Practice Address - Zip Code:48170-6530
Practice Address - Country:US
Practice Address - Phone:734-259-7102
Practice Address - Fax:734-259-7104
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-11
Last Update Date:2011-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty