Provider Demographics
NPI:1972613529
Name:ADVANCED REHABILITATION CLINIC, INC.
Entity type:Organization
Organization Name:ADVANCED REHABILITATION CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:DANESHVAR
Authorized Official - Suffix:
Authorized Official - Credentials:RPT PHD
Authorized Official - Phone:248-442-2020
Mailing Address - Street 1:33466 WEST 8 MILE RD
Mailing Address - Street 2:STE 111
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48335
Mailing Address - Country:US
Mailing Address - Phone:248-442-2020
Mailing Address - Fax:248-442-8100
Practice Address - Street 1:33466 WEST 8 MILE RD
Practice Address - Street 2:STE 111
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48335
Practice Address - Country:US
Practice Address - Phone:248-442-2020
Practice Address - Fax:248-442-8100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2012-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
30366OtherBCBS
236597Medicare ID - Type Unspecified