1336202217 NPI number — MICHIGAN REHABILITATION SPECIALISTS OF SOUTH LYON LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336202217 NPI number — MICHIGAN REHABILITATION SPECIALISTS OF SOUTH LYON LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MICHIGAN REHABILITATION SPECIALISTS OF SOUTH LYON LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1336202217
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/08/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
25700 PONTIAC TRL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SOUTH LYON
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48178-8047
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-366-0403
Provider Business Mailing Address Fax Number:
248-366-0251

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
25700 PONTIAC TRL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SOUTH LYON
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48178-8047
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-366-0403
Provider Business Practice Location Address Fax Number:
248-366-0251
Provider Enumeration Date:
12/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ROOKS
Authorized Official First Name:
FRANKLIN
Authorized Official Middle Name:
J
Authorized Official Title or Position:
COO
Authorized Official Telephone Number:
810-231-8904

Provider Taxonomy Codes

  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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