Provider Demographics
NPI:1982770673
Name:NORTHVILLE PHYSICAL REHABILITATION, P.C.
Entity type:Organization
Organization Name:NORTHVILLE PHYSICAL REHABILITATION, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:E
Authorized Official - Last Name:ENGERER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-349-9339
Mailing Address - Street 1:215 E MAIN ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:NORTHVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48167-1681
Mailing Address - Country:US
Mailing Address - Phone:248-349-9339
Mailing Address - Fax:248-349-9342
Practice Address - Street 1:215 E MAIN ST
Practice Address - Street 2:SUITE B
Practice Address - City:NORTHVILLE
Practice Address - State:MI
Practice Address - Zip Code:48167-1681
Practice Address - Country:US
Practice Address - Phone:248-349-9339
Practice Address - Fax:248-349-9342
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-27
Last Update Date:2024-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501002317225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI500573OtherCARE CHOICES
MI7543420OtherAETNA PIN
MI0N58620OtherHAP
MIP00100555OtherMEDICARE RAILROAD
MI16869OtherMCARE
MA16869OtherPARTNERSHIP HEALTH
MIOH20094OtherBCBS
MI7543420OtherAETNA PIN