Health Source Rehab, LLC

Primary specialty

Physical Therapy Clinic/CenterTaxonomy code 261QP2000X

Legal business name

HEALTH SOURCE REHAB, LLC

Practice address

4100 E 11 Mile Rd
Warren, MI 48091-1192

Phone

(586) 757-2440

Fax

(586) 757-2441

NPI assigned

Oct 4, 2013

Last updated

Oct 4, 2013By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Augusto Dayco

Title

Director

Phone

(586) 757-2440

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1380844800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1380844800000",
    "number": "1134556103",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4100 E 11 MILE RD",
            "city": "WARREN",
            "state": "MI",
            "postal_code": "480911192",
            "telephone_number": "586-757-2440",
            "fax_number": "586-757-2441"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4100 E 11 MILE RD",
            "city": "WARREN",
            "state": "MI",
            "postal_code": "480911192",
            "telephone_number": "586-757-2440",
            "fax_number": "586-757-2441"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HEALTH SOURCE REHAB, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-10-04",
        "last_updated": "2013-10-04",
        "status": "A",
        "authorized_official_last_name": "DAYCO",
        "authorized_official_first_name": "AUGUSTO",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "586-757-2440",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Physical Therapy Clinic/Center in Warren, MI
• Providers in Warren, MI by specialty
• Physical Therapy Clinic/Center in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 4, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.