Provider Demographics
NPI:1154386563
Name:HAMTRAMCK PHYSICAL THERAPHY AND REHAB SERVICES, INC.
Entity type:Organization
Organization Name:HAMTRAMCK PHYSICAL THERAPHY AND REHAB SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SAN TOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-552-0283
Mailing Address - Street 1:20755 GREENFIELD RD
Mailing Address - Street 2:SUITE 803
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-5403
Mailing Address - Country:US
Mailing Address - Phone:248-552-0283
Mailing Address - Fax:248-552-0576
Practice Address - Street 1:20755 GREENFIELD RD
Practice Address - Street 2:SUITE 803
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-5403
Practice Address - Country:US
Practice Address - Phone:248-552-0283
Practice Address - Fax:248-552-0576
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-19
Last Update Date:2007-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
305R00000X
MI236789305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI236789OtherPROVIDER NUMBER (MEDICARE