Provider Demographics
NPI:1104219765
Name:COPTIC PHYSICAL THERAPY & REHABILITATION INC
Entity type:Organization
Organization Name:COPTIC PHYSICAL THERAPY & REHABILITATION INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:YOUNAN
Authorized Official - Middle Name:HANNA
Authorized Official - Last Name:MIKHAIL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:831-207-6787
Mailing Address - Street 1:725 BARCLAY CIR
Mailing Address - Street 2:SUITE 240
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48307-5808
Mailing Address - Country:US
Mailing Address - Phone:248-606-4022
Mailing Address - Fax:248-289-6927
Practice Address - Street 1:745 BARCLAY CIR
Practice Address - Street 2:SUITE 240
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48307-5810
Practice Address - Country:US
Practice Address - Phone:831-207-6787
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-06
Last Update Date:2015-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)