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Organization

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Active
Organization subpart
No

Provider details

NPI number
Authorized official
MRS. AMY REZVAN (CEO)
(248) 884-0048
Entity
Organization

Contact information

Practice address
29688 TELEGRAPH RD STE 400, SOUTHFIELD, MI 48034-1364
(248) 884-0048
Mailing address
29688 TELEGRAPH RD STE 400, SOUTHFIELD, MI 48034-1364

Taxonomy

Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
225700000X
Massage Therapist
225XM0800X
Mental Health Occupational Therapist
225XP0019X
Physical Rehabilitation Occupational Therapist

Other

Enumeration date
02/22/2019
Last updated
02/22/2019
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