Provider Demographics
NPI:1851935043
Name:PHYSICAL REHABILITATION PROFESSIONALS, PLLC
Entity Type:Organization
Organization Name:PHYSICAL REHABILITATION PROFESSIONALS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:M
Authorized Official - Last Name:BEATTY
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:734-250-0778
Mailing Address - Street 1:PO BOX 176
Mailing Address - Street 2:
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48376-0176
Mailing Address - Country:US
Mailing Address - Phone:734-250-0778
Mailing Address - Fax:734-480-8829
Practice Address - Street 1:35675 WARREN RD STE 10
Practice Address - Street 2:
Practice Address - City:WESTLAND
Practice Address - State:MI
Practice Address - Zip Code:48185-2015
Practice Address - Country:US
Practice Address - Phone:734-722-5400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-31
Last Update Date:2020-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy