Provider Demographics
NPI:1962048405
Name:PHYSIO CARE REHAB LLC
Entity type:Organization
Organization Name:PHYSIO CARE REHAB LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PT
Authorized Official - Prefix:
Authorized Official - First Name:THIRUPATHI
Authorized Official - Middle Name:
Authorized Official - Last Name:ALLALA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-476-1780
Mailing Address - Street 1:PO BOX 2190
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48333-2190
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10645 W WARREN AVE STE 300
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126-8009
Practice Address - Country:US
Practice Address - Phone:813-476-1780
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-19
Last Update Date:2019-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy