Provider Demographics
NPI:1851487219
Name:TRENTON PHYSICAL THERAPY & REHAB INC
Entity Type:Organization
Organization Name:TRENTON PHYSICAL THERAPY & REHAB INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:TAHIRA
Authorized Official - Middle Name:
Authorized Official - Last Name:PERVEEN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:734-285-7011
Mailing Address - Street 1:13400 FORT ST
Mailing Address - Street 2:
Mailing Address - City:SOUTHGATE
Mailing Address - State:MI
Mailing Address - Zip Code:48195-1138
Mailing Address - Country:US
Mailing Address - Phone:734-285-7011
Mailing Address - Fax:734-285-7050
Practice Address - Street 1:13400 FORT ST
Practice Address - Street 2:
Practice Address - City:SOUTHGATE
Practice Address - State:MI
Practice Address - Zip Code:48195-1138
Practice Address - Country:US
Practice Address - Phone:734-285-7011
Practice Address - Fax:734-285-7050
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
23-6728Medicare ID - Type Unspecified