1174562037 NPI number — TOTAL PHYSICAL THERAPY & REHABILITATION,INC

Table of content: (NPI 1174562037)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174562037 NPI number — TOTAL PHYSICAL THERAPY & REHABILITATION,INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TOTAL PHYSICAL THERAPY & REHABILITATION,INC
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:
1174562037
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/02/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
811 OAKWOOD
Provider Second Line Business Mailing Address:
STE 102
Provider Business Mailing Address City Name:
ROCHESTER
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48307
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-656-1985
Provider Business Mailing Address Fax Number:
248-656-3729

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
811 OAKWOOD
Provider Second Line Business Practice Location Address:
STE 102
Provider Business Practice Location Address City Name:
ROCHESTER
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48307
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-656-1985
Provider Business Practice Location Address Fax Number:
248-656-3729
Provider Enumeration Date:
06/06/2006

Additional Information

Authorized Official

Authorized Official Last Name:
UH
Authorized Official First Name:
KYOUNG
Authorized Official Middle Name:
HONG
Authorized Official Title or Position:
OWNER ADMINSITRATOR
Authorized Official Telephone Number:
248-656-1985

Provider Taxonomy Codes

  • Taxonomy code: 261QR0401X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 30614 . This is a "BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7606734 . This is a "AENTA" identifier . This identifiers is of the category "OTHER".




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