Provider Demographics
NPI:1972049948
Name:TEAM REHABILITATION IN08, LLC
Entity Type:Organization
Organization Name:TEAM REHABILITATION IN08, LLC
Other - Org Name:
Other - Org Type:
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:586-350-2644
Mailing Address - Street 1:33900 HARPER AVE
Mailing Address - Street 2:SUITE 104
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 1:6640 PARKDALE PL
Practice Address - Street 2:SUITE T
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46254-5619
Practice Address - Country:US
Practice Address - Phone:317-808-7070
Practice Address - Fax:317-808-7073
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TEAM REHABILITATION SERVICES, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-01-13
Last Update Date:2019-02-06
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