Organization
FORMA REHABILITATION, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRYAN GENRICH (AUTHORIZED OFFICIAL)
(248) 862-7760
Entity
Organization
Contact information
Practice address
24100 DRAKE RD, STE B, FARMINGTON HILLS, MI 48335
(248) 471-9414
(248) 442-5012
Mailing address
28104 ORCHARD LAKE RD, SUITE 110, FARMINGTON HILLS, MI 48334-3701
(248) 539-9278
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
—
—
Other
Enumeration date
05/27/2016
Last updated
06/25/2018
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