Organization Name: | PHOENIX REHABILITATION SERVICE |
NPI Number: | 1134492499 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | NEMR HAMAD (OWNER) |
Mailing Address: | 624 E 9 Mile Rd Hazel Park |
State: | MI US |
Postal Code: | 480301842 |
Phone Number: | 3135255554 |
Fax Number: | |
NPI Enumeration Date: | 02/17/2012 |
NPI Last Update Date: | 02/17/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QP2000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Physical Therapy |
Taxonomy Definition: |