Provider Demographics
NPI:1255383295
Name:US REHABILITATILN,INC
Entity type:Organization
Organization Name:US REHABILITATILN,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:SIRAJ
Authorized Official - Middle Name:
Authorized Official - Last Name:HAQ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-287-4211
Mailing Address - Street 1:21801 GODDARD RD
Mailing Address - Street 2:
Mailing Address - City:TAYLOR
Mailing Address - State:MI
Mailing Address - Zip Code:48180-4213
Mailing Address - Country:US
Mailing Address - Phone:734-287-4211
Mailing Address - Fax:734-287-2266
Practice Address - Street 1:21801 GODDARD RD
Practice Address - Street 2:
Practice Address - City:TAYLOR
Practice Address - State:MI
Practice Address - Zip Code:48180-4213
Practice Address - Country:US
Practice Address - Phone:734-287-4211
Practice Address - Fax:734-287-2266
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI236749Medicare ID - Type UnspecifiedPROVIDER NO.