Provider Demographics
NPI:1720643059
Name:180 DEGREE REHAB LLC
Entity Type:Organization
Organization Name:180 DEGREE REHAB LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:SYRIAC
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:248-987-2855
Mailing Address - Street 1:40200 GRAND RIVER AVE STE 400
Mailing Address - Street 2:
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48375-2146
Mailing Address - Country:US
Mailing Address - Phone:248-987-2855
Mailing Address - Fax:248-957-6713
Practice Address - Street 1:40200 GRAND RIVER AVE STE 400
Practice Address - Street 2:
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48375-2146
Practice Address - Country:US
Practice Address - Phone:248-987-2855
Practice Address - Fax:248-957-6713
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-02
Last Update Date:2019-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty