Provider Demographics
NPI:1336416528
Name:DIVINE REHAB SERVICES INC
Entity Type:Organization
Organization Name:DIVINE REHAB SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:RONY
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:RPT
Authorized Official - Phone:248-825-9506
Mailing Address - Street 1:35450 DEQUINDRE RD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48310-4810
Mailing Address - Country:US
Mailing Address - Phone:248-835-9506
Mailing Address - Fax:
Practice Address - Street 1:35450 DEQUINDRE RD
Practice Address - Street 2:SUITE 106
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48310-4810
Practice Address - Country:US
Practice Address - Phone:248-835-9506
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-16
Last Update Date:2011-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501014058261QP2000X
MI5501012722261QP2000X
MI5501010148261QP2000X
MI5501010166261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy