Provider Demographics
NPI:1750618898
Name:AUTO & WORK COMP REHAB LLC
Entity type:Organization
Organization Name:AUTO & WORK COMP REHAB LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHEAL
Authorized Official - Middle Name:NOSHY
Authorized Official - Last Name:FAHMY
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:248-353-1234
Mailing Address - Street 1:29255 NORTHWESTERN HWY
Mailing Address - Street 2:STE 300
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48034-1018
Mailing Address - Country:US
Mailing Address - Phone:248-353-1234
Mailing Address - Fax:248-353-1211
Practice Address - Street 1:29255 NORTHWESTERN HWY
Practice Address - Street 2:STE 300
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-1018
Practice Address - Country:US
Practice Address - Phone:248-353-1234
Practice Address - Fax:248-353-1211
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OMPT SPECIALISTS,INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-11-11
Last Update Date:2009-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501008179261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy