Provider Demographics
NPI:1245301035
Name:STANDARD REHABILITATION INC
Entity type:Organization
Organization Name:STANDARD REHABILITATION INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MONSURU
Authorized Official - Middle Name:
Authorized Official - Last Name:BELLO
Authorized Official - Suffix:
Authorized Official - Credentials:RPT
Authorized Official - Phone:248-821-4951
Mailing Address - Street 1:25368 CAROLLTON DR
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48335-1309
Mailing Address - Country:US
Mailing Address - Phone:248-821-4951
Mailing Address - Fax:248-888-0467
Practice Address - Street 1:27327 SOUTHFIELD RD
Practice Address - Street 2:
Practice Address - City:LATHRUP VILLAGE
Practice Address - State:MI
Practice Address - Zip Code:48076-3408
Practice Address - Country:US
Practice Address - Phone:248-552-0367
Practice Address - Fax:248-888-0467
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501005574225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MION22410Medicare ID - Type UnspecifiedPHYSICAL THERAPY