Provider Demographics
NPI:1952766826
Name:TRIRIGA REHAB LLC
Entity Type:Organization
Organization Name:TRIRIGA REHAB LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:JIMS
Authorized Official - Middle Name:T
Authorized Official - Last Name:VARGHESE
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:248-805-4181
Mailing Address - Street 1:800 W LONG LAKE RD STE 103
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48302-2033
Mailing Address - Country:US
Mailing Address - Phone:248-480-0900
Mailing Address - Fax:
Practice Address - Street 1:800 W LONG LAKE RD STE 103
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48302-2033
Practice Address - Country:US
Practice Address - Phone:248-480-0900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-21
Last Update Date:2020-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy