Provider Demographics
NPI:1831275270
Name:LORDS PHYSICAL THERAPY AND REHAB SERVICES
Entity type:Organization
Organization Name:LORDS PHYSICAL THERAPY AND REHAB SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SHAMNATH
Authorized Official - Middle Name:A
Authorized Official - Last Name:RAHIM
Authorized Official - Suffix:
Authorized Official - Credentials:RPT
Authorized Official - Phone:313-297-3233
Mailing Address - Street 1:1920 JUNCTION ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48209-2168
Mailing Address - Country:US
Mailing Address - Phone:313-739-3505
Mailing Address - Fax:
Practice Address - Street 1:1920 JUNCTION ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48209-2168
Practice Address - Country:US
Practice Address - Phone:313-739-3505
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0P37130Medicare ID - Type UnspecifiedPHYSICAL THERAPY