Provider Demographics
NPI:1780994301
Name:NORTHWESTERN REHABILITATION SERVICES LLC
Entity type:Organization
Organization Name:NORTHWESTERN REHABILITATION SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JIMS
Authorized Official - Middle Name:THANKACHAN
Authorized Official - Last Name:VARGHESE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:248-352-4984
Mailing Address - Street 1:23999 NORTHWESTERN HWY
Mailing Address - Street 2:SUITE 105
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-2578
Mailing Address - Country:US
Mailing Address - Phone:248-352-4984
Mailing Address - Fax:248-352-5765
Practice Address - Street 1:23999 NORTHWESTERN HWY
Practice Address - Street 2:SUITE 105
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-2578
Practice Address - Country:US
Practice Address - Phone:248-352-4984
Practice Address - Fax:248-352-5765
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-15
Last Update Date:2010-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty