1760661631 NPI number — PROFESSIONAL QUALITY REHAB SERVICES,INC

Table of content: MS. MARY ELLEN BRADY KOVACS L.P.C. (NPI 1457552598)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760661631 NPI number — PROFESSIONAL QUALITY REHAB SERVICES,INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PROFESSIONAL QUALITY REHAB SERVICES,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:
1760661631
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/02/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7460 DRY CREEK DR APT 2A
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GRAND BLANC
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48439-6313
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
810-265-3882
Provider Business Mailing Address Fax Number:
810-963-0560

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7460 DRY CREEK DR APT 2A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GRAND BLANC
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48439-6313
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
810-265-3882
Provider Business Practice Location Address Fax Number:
810-963-0560
Provider Enumeration Date:
10/29/2007

Additional Information

Authorized Official

Authorized Official Last Name:
KRISHNAMOORTHY
Authorized Official First Name:
MADHAVAN
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
810-230-0891

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  5501007308 , 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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