Provider Demographics
NPI:1972666022
Name:PHYSICARE REHAB, INC.
Entity Type:Organization
Organization Name:PHYSICARE REHAB, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:M.R.
Authorized Official - Middle Name:
Authorized Official - Last Name:HYDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:586-447-1327
Mailing Address - Street 1:23600 HARPER AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SAINT CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48080-1445
Mailing Address - Country:US
Mailing Address - Phone:586-447-1327
Mailing Address - Fax:586-447-1406
Practice Address - Street 1:23600 HARPER AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:SAINT CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48080-1445
Practice Address - Country:US
Practice Address - Phone:586-447-1327
Practice Address - Fax:586-447-1406
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI30447OtherBLUE CROSS BLUE SHIELD MI
MI30447OtherBLUE CROSS BLUE SHIELD MI