Provider Demographics
NPI:1962999607
Name:SPECIALISTS IN REHABILITATION MEDICINE PC
Entity type:Organization
Organization Name:SPECIALISTS IN REHABILITATION MEDICINE PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:ROTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-650-5861
Mailing Address - Street 1:8391 COMMERCE RD STE 107
Mailing Address - Street 2:
Mailing Address - City:COMMERCE TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48382-4489
Mailing Address - Country:US
Mailing Address - Phone:248-360-8660
Mailing Address - Fax:248-360-9235
Practice Address - Street 1:8391 COMMERCE RD STE 107
Practice Address - Street 2:
Practice Address - City:COMMERCE TWP
Practice Address - State:MI
Practice Address - Zip Code:48382-4489
Practice Address - Country:US
Practice Address - Phone:248-360-8660
Practice Address - Fax:248-360-9235
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SPECIALISTS IN REHABILITATION MEDICINE PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-04-18
Last Update Date:2018-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty