Provider Demographics
NPI:1992139562
Name:PHYSICAL REHAB SERVICES LLC
Entity type:Organization
Organization Name:PHYSICAL REHAB SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BERNARD
Authorized Official - Middle Name:
Authorized Official - Last Name:FOSTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:586-944-2323
Mailing Address - Street 1:21331 KELLY RD
Mailing Address - Street 2:STE 140A
Mailing Address - City:EASTPOINTE
Mailing Address - State:MI
Mailing Address - Zip Code:48021
Mailing Address - Country:US
Mailing Address - Phone:586-944-2323
Mailing Address - Fax:
Practice Address - Street 1:21331 KELLY RD
Practice Address - Street 2:STE 140A
Practice Address - City:EASTPOINTE
Practice Address - State:MI
Practice Address - Zip Code:48021
Practice Address - Country:US
Practice Address - Phone:586-944-2323
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-30
Last Update Date:2016-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy