Provider Demographics
NPI:1700154481
Name:SUBLIME PHYSICAL THERAPY & REHAB SERVICES
Entity Type:Organization
Organization Name:SUBLIME PHYSICAL THERAPY & REHAB SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SYED
Authorized Official - Middle Name:IRFAN HAIDER
Authorized Official - Last Name:JILANI
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:313-581-3200
Mailing Address - Street 1:4937 SCHAEFER RD
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48126-3251
Mailing Address - Country:US
Mailing Address - Phone:313-945-9366
Mailing Address - Fax:313-945-0070
Practice Address - Street 1:13244 W WARREN AVE
Practice Address - Street 2:SUITE 3
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126-1415
Practice Address - Country:US
Practice Address - Phone:313-581-3200
Practice Address - Fax:313-581-9085
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-08
Last Update Date:2011-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501006285225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOH25779OtherBCBS
MIOH25779OtherBCBS