Provider Demographics
NPI:1801954508
Name:PERFORMANCE REHAB INC
Entity type:Organization
Organization Name:PERFORMANCE REHAB INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:SANJAY
Authorized Official - Middle Name:
Authorized Official - Last Name:THAKRAL
Authorized Official - Suffix:
Authorized Official - Credentials:RPT
Authorized Official - Phone:313-359-9595
Mailing Address - Street 1:PO BOX 703207
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MI
Mailing Address - Zip Code:48170-0994
Mailing Address - Country:US
Mailing Address - Phone:313-359-9595
Mailing Address - Fax:313-359-9585
Practice Address - Street 1:8565 N SILVERY LN
Practice Address - Street 2:SUITE 401
Practice Address - City:DEARBORN HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48127-4517
Practice Address - Country:US
Practice Address - Phone:313-359-9595
Practice Address - Fax:313-359-9585
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501006790225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI650H230480OtherBCBC BCN
MI7505869OtherAETNA
MIDN5971OtherRAILROAD MEDICARE GROUP
MI4968677Medicaid
MI4968677Medicaid