Provider Demographics
NPI:1912049842
Name:SPINAL & ORTHOPEDIC REHABILITATION III LLC
Entity Type:Organization
Organization Name:SPINAL & ORTHOPEDIC REHABILITATION III LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:H
Authorized Official - Last Name:KEILA
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:313-865-9400
Mailing Address - Street 1:16251 WOODWARD AVE
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48203-2867
Mailing Address - Country:US
Mailing Address - Phone:313-865-9400
Mailing Address - Fax:313-865-9401
Practice Address - Street 1:16251 WOODWARD AVE
Practice Address - Street 2:
Practice Address - City:HIGHLAND PARK
Practice Address - State:MI
Practice Address - Zip Code:48203-2867
Practice Address - Country:US
Practice Address - Phone:313-865-9400
Practice Address - Fax:313-865-9401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty