Provider Demographics
NPI:1336458876
Name:DYNAMIC REHAB SERVICES INC
Entity Type:Organization
Organization Name:DYNAMIC REHAB SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MUSTAFA
Authorized Official - Middle Name:
Authorized Official - Last Name:MANZUR
Authorized Official - Suffix:
Authorized Official - Credentials:RPT
Authorized Official - Phone:248-727-4322
Mailing Address - Street 1:34909 BUNKER HILL DR
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48331-3285
Mailing Address - Country:US
Mailing Address - Phone:248-727-4322
Mailing Address - Fax:734-451-0603
Practice Address - Street 1:16904 W WARREN AVE
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48228-3505
Practice Address - Country:US
Practice Address - Phone:313-945-5926
Practice Address - Fax:734-451-0603
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-01
Last Update Date:2010-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501006945225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty