Provider Demographics
NPI:1417503715
Name:PHYSIATRY AND REHABILITATION ASSOCIATES LLC
Entity type:Organization
Organization Name:PHYSIATRY AND REHABILITATION ASSOCIATES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:USAMA
Authorized Official - Middle Name:
Authorized Official - Last Name:GABR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:513-309-8523
Mailing Address - Street 1:2700 S ROCHESTER RD STE A
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48307-4547
Mailing Address - Country:US
Mailing Address - Phone:248-212-0777
Mailing Address - Fax:248-575-4144
Practice Address - Street 1:113 BLARNEY DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29223-6244
Practice Address - Country:US
Practice Address - Phone:803-788-2225
Practice Address - Fax:803-788-2120
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-13
Last Update Date:2024-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI282287Medicaid