1548330848 NPI number — NESAM CONCEPTS PHYSICAL THERAPY& REHABILITATION

Table of content: (NPI 1548330848)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548330848 NPI number — NESAM CONCEPTS PHYSICAL THERAPY& REHABILITATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NESAM CONCEPTS PHYSICAL THERAPY& REHABILITATION
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:
NESAM CONCEPTS PHYSICAL THERAPY & REHABILITATION
Provider Other Organization Name Type Code:
3
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:
1548330848
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/27/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
752 SOUTHFIELD ROAD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LINCOLN PARK
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48146
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
313-388-7110
Provider Business Mailing Address Fax Number:
313-388-7424

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
17500 NORTHLAND PARK CT STE 1
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SOUTHFIELD
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48075-4324
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
313-388-7110
Provider Business Practice Location Address Fax Number:
313-388-7424
Provider Enumeration Date:
11/08/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
NANA
Authorized Official First Name:
EDEWOR
Authorized Official Middle Name:
SPLENDID
Authorized Official Title or Position:
PHYSICAL THERAPIST
Authorized Official Telephone Number:
313-388-7110

Provider Taxonomy Codes

  • Taxonomy code: 2251X0800X , with the licence number:  5501006444 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 4297616 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: P112871 . This is a "BSBS" identifier . This identifiers is of the category "OTHER".