Provider Demographics
NPI:1174562037
Name:TOTAL PHYSICAL THERAPY & REHABILITATION,INC
Entity type:Organization
Organization Name:TOTAL PHYSICAL THERAPY & REHABILITATION,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER ADMINSITRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:KYOUNG
Authorized Official - Middle Name:HONG
Authorized Official - Last Name:UH
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:248-656-1985
Mailing Address - Street 1:811 OAKWOOD
Mailing Address - Street 2:STE 102
Mailing Address - City:ROCHESTER
Mailing Address - State:MI
Mailing Address - Zip Code:48307
Mailing Address - Country:US
Mailing Address - Phone:248-656-1985
Mailing Address - Fax:248-656-3729
Practice Address - Street 1:811 OAKWOOD
Practice Address - Street 2:STE 102
Practice Address - City:ROCHESTER
Practice Address - State:MI
Practice Address - Zip Code:48307
Practice Address - Country:US
Practice Address - Phone:248-656-1985
Practice Address - Fax:248-656-3729
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-06
Last Update Date:2017-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)
Provider Identifiers
StateIdentifier IDID TypeIssuer
30614OtherBCBS
7606734OtherAENTA
7606734OtherAENTA