Provider Demographics
NPI:1891110185
Name:ACCESS PHYSICAL THERAPY & REHAB LLC
Entity Type:Organization
Organization Name:ACCESS PHYSICAL THERAPY & REHAB LLC
Other - Org Name:ACCESS PHYSICAL THERAPY & REHAB LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMIN
Authorized Official - Prefix:MR
Authorized Official - First Name:GIGI
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:586-344-6353
Mailing Address - Street 1:15700 PROVIDENCE DR
Mailing Address - Street 2:ROOM# 400
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-3144
Mailing Address - Country:US
Mailing Address - Phone:586-344-6353
Mailing Address - Fax:248-415-6289
Practice Address - Street 1:15700 PROVIDENCE DR
Practice Address - Street 2:ROOM# 400
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-3144
Practice Address - Country:US
Practice Address - Phone:586-344-6353
Practice Address - Fax:248-415-6289
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-24
Last Update Date:2014-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501010680261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy