Provider Demographics
NPI:1295258374
Name:STAYFIT REHAB INC
Entity type:Organization
Organization Name:STAYFIT REHAB INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GANESHKUMAR
Authorized Official - Middle Name:
Authorized Official - Last Name:SHANMUGASUNDARAM
Authorized Official - Suffix:
Authorized Official - Credentials:RPT
Authorized Official - Phone:248-334-9003
Mailing Address - Street 1:2191 SOUTH BVLD
Mailing Address - Street 2:STE 203
Mailing Address - City:AUBURN HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48326
Mailing Address - Country:US
Mailing Address - Phone:248-334-9003
Mailing Address - Fax:248-334-9334
Practice Address - Street 1:2191 SOUTH BLVD
Practice Address - Street 2:SUITE 203
Practice Address - City:AUBURN HILLS
Practice Address - State:MI
Practice Address - Zip Code:48326-4832
Practice Address - Country:US
Practice Address - Phone:248-334-9003
Practice Address - Fax:248-334-9334
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-20
Last Update Date:2017-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QP2000X
MI261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy