Organization
INDIVIDUALIZED PHYSICAL THERAPY & REHAB P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ABRAHAM PANACHAKUNNIL JOSEPH (ADMINISTRATOR)
(248) 946-2504
Entity
Organization
Contact information
Practice address
44633 JOY RD, CANTON, MI 48187
(734) 710-6600
(734) 710-3002
Mailing address
44633 JOY RD, CANTON, MI 48187-1730
(734) 710-6600
(734) 710-3002
Taxonomy
Speciality
Code
Description
License number
State
261QR0400X
Rehabilitation Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
30381
BLUE CROSS BLUE SHIELD
MI
Enumeration date
09/21/2006
Last updated
05/09/2016
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