Provider Demographics
NPI:1306280219
Name:CUSTOM REHAB SOLUTIONS, INC.
Entity type:Organization
Organization Name:CUSTOM REHAB SOLUTIONS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:FRED
Authorized Official - Middle Name:M
Authorized Official - Last Name:HETHERWICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:517-945-4980
Mailing Address - Street 1:8250 LOCKERBIE RD
Mailing Address - Street 2:
Mailing Address - City:PARMA
Mailing Address - State:MI
Mailing Address - Zip Code:49269-9335
Mailing Address - Country:US
Mailing Address - Phone:517-740-8875
Mailing Address - Fax:
Practice Address - Street 1:8250 LOCKERBIE RD
Practice Address - Street 2:
Practice Address - City:PARMA
Practice Address - State:MI
Practice Address - Zip Code:49269-9335
Practice Address - Country:US
Practice Address - Phone:517-740-8875
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-22
Last Update Date:2013-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1379518172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172M00000XOther Service ProvidersMechanotherapistGroup - Multi-Specialty