Provider Demographics
NPI:1649011743
Name:REHAB LAB LLC
Entity type:Organization
Organization Name:REHAB LAB LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DANNY
Authorized Official - Middle Name:
Authorized Official - Last Name:AZZOW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-939-0052
Mailing Address - Street 1:53772 REGENCY HILLS CT
Mailing Address - Street 2:
Mailing Address - City:SHELBY TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48316-2047
Mailing Address - Country:US
Mailing Address - Phone:248-939-0052
Mailing Address - Fax:
Practice Address - Street 1:884 S ROCHESTER RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48307-2740
Practice Address - Country:US
Practice Address - Phone:248-781-4374
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-03
Last Update Date:2024-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty