Provider Demographics
NPI:1982806220
Name:SUB REHABILITATION & PHYSICAL THERAPY SERVICES, INC
Entity type:Organization
Organization Name:SUB REHABILITATION & PHYSICAL THERAPY SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:KISHORI
Authorized Official - Middle Name:L
Authorized Official - Last Name:BARPAGA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-842-2232
Mailing Address - Street 1:10136 W VERNOR AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48120-1515
Mailing Address - Country:US
Mailing Address - Phone:313-842-2232
Mailing Address - Fax:313-842-2221
Practice Address - Street 1:10136 W VERNOR AVE
Practice Address - Street 2:SUITE B
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48120-1515
Practice Address - Country:US
Practice Address - Phone:313-842-2232
Practice Address - Fax:313-842-2221
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy