Provider Demographics
NPI:1356024442
Name:ADVANCE PHYSICAL THERAPY AND REHAB CENTER OF MICHIGAN
Entity type:Organization
Organization Name:ADVANCE PHYSICAL THERAPY AND REHAB CENTER OF MICHIGAN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:IRAM
Authorized Official - Middle Name:Q
Authorized Official - Last Name:TARIQ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-482-3181
Mailing Address - Street 1:26211 CENTRAL PARK BLVD STE 116
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48076-4107
Mailing Address - Country:US
Mailing Address - Phone:248-291-7516
Mailing Address - Fax:
Practice Address - Street 1:26211 CENTRAL PARK BLVD STE 116
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48076-4107
Practice Address - Country:US
Practice Address - Phone:248-291-7516
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-07
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty