Provider Demographics
NPI:1457356453
Name:PRIME REHAB AND PHYSICAL THERAPY INC
Entity type:Organization
Organization Name:PRIME REHAB AND PHYSICAL THERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MUHAMMAD
Authorized Official - Middle Name:
Authorized Official - Last Name:SADIQ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-357-3079
Mailing Address - Street 1:7140 W FORT ST
Mailing Address - Street 2:STE 4
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48209-2917
Mailing Address - Country:US
Mailing Address - Phone:313-357-3079
Mailing Address - Fax:313-388-0593
Practice Address - Street 1:2900 S FORT ST
Practice Address - Street 2:STE 3
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48217-1061
Practice Address - Country:US
Practice Address - Phone:313-388-0156
Practice Address - Fax:313-388-0593
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-16
Last Update Date:2012-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4676467Medicaid
MI236805Medicare ID - Type UnspecifiedREHAB CLNIC