Alexis Rehab Services PC

Primary specialty

Physical Therapy Clinic/CenterTaxonomy code 261QP2000X

Legal business name

ALEXIS REHAB SERVICES PC

Practice address

4045 W 13 Mile Rd Ste C
Royal Oak, MI 48073-6640

Phone

(248) 583-5340

Fax

(248) 565-8213

NPI assigned

Aug 4, 2006

Last updated

Aug 24, 2023By 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. Ikram Ul Haq, RPT

Title

Administrator

Phone

(248) 443-7300

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in MI

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1639187305. Details of each certification follow.

• CCN 236719 Outpatient physical therapy / speech pathology · Active · Name & address match · Details

Outpatient physical therapy / speech pathology certification: CCN 236719

Legal name

Alexis Rehab Services, PC

Certification status

Active

Provider type (POS)

Outpatient physical therapy / speech pathology

Participating since

Apr 25, 1997

Last certification

Aug 21, 2019

Ownership / control type

Proprietary

Facility address

4045 West 13 Mile Rd, Suite C
Royal Oak, MI 48073

Locations

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

{
    "created_epoch": "1154649600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1692835200000",
    "number": "1639187305",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17700 NORTHLAND PARK CT",
            "address_2": "SUITE 1-A",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480754302",
            "telephone_number": "248-443-7300",
            "fax_number": "248-424-9870"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4045 W 13 MILE RD STE C",
            "city": "ROYAL OAK",
            "state": "MI",
            "postal_code": "480736640",
            "telephone_number": "248-583-5340",
            "fax_number": "248-565-8213"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "17700 Northland Park Ct",
            "address_2": "Suite 1-A",
            "address_purpose": "LOCATION",
            "city": "Southfield",
            "state": "MI",
            "postal_code": "480754302",
            "country_code": "US",
            "telephone_number": "248-443-7300",
            "fax_number": "248-424-9870",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "ALEXIS REHAB SERVICES PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-04",
        "last_updated": "2023-08-24",
        "certification_date": "2023-08-24",
        "status": "A",
        "authorized_official_last_name": "HAQ",
        "authorized_official_first_name": "IKRAM",
        "authorized_official_middle_name": "UL",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "248-443-7300",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "RPT"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4696503-40",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS MI OUT-PT REHAB",
            "identifier": "30681",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Mohannad Wail Mohd Aldarras, M.D.
• Nasser Ali Aldhaibani
• Valetta Aldridge
• Amanda Sally Alexander, MD
• Jillian Paige-Sue Alexander, OTRL
• Michael Alfonsi, MS, LAT, ATC
• Ibraheem Algabry
• Mohamad Mazen Alhakim, MD
• Hussein Alhashemy, MD
• Ahmed Hamood Ali, MD

• Physical Therapy Clinic/Center in Royal Oak, MI
• Providers in Royal Oak, 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 Aug 24, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.