Provider Demographics
NPI:1255355871
Name:REHABILITATION SPECIALISTS OF MONROE P C
Entity type:Organization
Organization Name:REHABILITATION SPECIALISTS OF MONROE P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:ROYDON
Authorized Official - Last Name:BARBOUR
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:734-241-0560
Mailing Address - Street 1:905 N MACOMB ST STE 3
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:MI
Mailing Address - Zip Code:48162-3076
Mailing Address - Country:US
Mailing Address - Phone:734-241-0560
Mailing Address - Fax:734-241-3230
Practice Address - Street 1:905 N MACOMB ST STE 3
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:MI
Practice Address - Zip Code:48162-3076
Practice Address - Country:US
Practice Address - Phone:734-241-0560
Practice Address - Fax:734-241-3230
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-27
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101008796208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI25-0-E8-1005-0OtherBCBS OF MICHIGAN
MI25-0-E8-1005-0OtherBCBS OF MICHIGAN