Provider Demographics
NPI:1336202217
Name:MICHIGAN REHABILITATION SPECIALISTS OF SOUTH LYON LLC
Entity Type:Organization
Organization Name:MICHIGAN REHABILITATION SPECIALISTS OF SOUTH LYON LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:FRANKLIN
Authorized Official - Middle Name:J
Authorized Official - Last Name:ROOKS
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:810-231-8904
Mailing Address - Street 1:25700 PONTIAC TRL
Mailing Address - Street 2:
Mailing Address - City:SOUTH LYON
Mailing Address - State:MI
Mailing Address - Zip Code:48178-8047
Mailing Address - Country:US
Mailing Address - Phone:248-366-0403
Mailing Address - Fax:248-366-0251
Practice Address - Street 1:25700 PONTIAC TRL
Practice Address - Street 2:
Practice Address - City:SOUTH LYON
Practice Address - State:MI
Practice Address - Zip Code:48178-8047
Practice Address - Country:US
Practice Address - Phone:248-366-0403
Practice Address - Fax:248-366-0251
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2012-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0P24060Medicare ID - Type Unspecified