Provider Demographics
NPI:1912906744
Name:METRO PHYSICAL THERAPY AND REHABILITATION, INC
Entity Type:Organization
Organization Name:METRO PHYSICAL THERAPY AND REHABILITATION, INC
Other - Org Name:METRO PHYSICAL THERAPY & REHABILITATION INC
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:IRAM
Authorized Official - Middle Name:Q
Authorized Official - Last Name:TARIQ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-424-7394
Mailing Address - Street 1:15565 NORTHLAND DR,
Mailing Address - Street 2:SUITE 208 E
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075
Mailing Address - Country:US
Mailing Address - Phone:248-424-7394
Mailing Address - Fax:248-424-7397
Practice Address - Street 1:15565 NORTHLAND DR E
Practice Address - Street 2:SUITE 208
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-5302
Practice Address - Country:US
Practice Address - Phone:248-424-7394
Practice Address - Fax:248-424-7397
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI30401OtherBCBSM
MI236554Medicare Oscar/Certification