Provider Demographics
NPI:1356031397
Name:PARAGON PHYSICAL THERAPY AND REHAB LLC
Entity type:Organization
Organization Name:PARAGON PHYSICAL THERAPY AND REHAB LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CCO
Authorized Official - Prefix:
Authorized Official - First Name:ALI
Authorized Official - Middle Name:
Authorized Official - Last Name:RATHUR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-765-4004
Mailing Address - Street 1:33469 W 14 MILE RD
Mailing Address - Street 2:SUITE 120
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48331
Mailing Address - Country:US
Mailing Address - Phone:248-765-4004
Mailing Address - Fax:
Practice Address - Street 1:15945 19 MILE RD
Practice Address - Street 2:SUITE B21
Practice Address - City:CLINTON TWP
Practice Address - State:MI
Practice Address - Zip Code:48038
Practice Address - Country:US
Practice Address - Phone:248-970-1153
Practice Address - Fax:248-254-3951
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-12
Last Update Date:2023-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy