1548531080 NPI number — TEAM REHABILITATION ST, 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 1548531080 NPI number — TEAM REHABILITATION ST, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TEAM REHABILITATION ST, 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:
1548531080
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/07/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
33900 HARPER AVE
Provider Second Line Business Mailing Address:
SUITE 104
Provider Business Mailing Address City Name:
CLINTON TOWNSHIP
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48035-4258
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
586-350-2644
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
50505 SCHOENHERR RD
Provider Second Line Business Practice Location Address:
SUITE 210P
Provider Business Practice Location Address City Name:
SHELBY TOWNSHIP
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48315-3140
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
586-884-6689
Provider Business Practice Location Address Fax Number:
586-884-6678
Provider Enumeration Date:
01/13/2012

Additional Information

Authorized Official

Authorized Official Last Name:
WEBER
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
NICHOLAS
Authorized Official Title or Position:
COO
Authorized Official Telephone Number:
586-350-2644

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , 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)





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