Ez Rest Re-Hab Center Inc.

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

5501005051 Issued in MI

Legal business name

EZ REST RE-HAB CENTER INC.

Practice address

25932 Dequindre Rd Ste C
Warren, MI 48091-1071

Phone

(248) 275-5221

Fax

(586) 486-5552

NPI assigned

May 1, 2013

Organization subpart

No

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

Authorized official

Name

Mr. Mark Wolodkowicz

Title

Owner

Phone

(248) 275-5221

Specialties & licenses 3

Addresses

Locations

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

{
    "created_epoch": "1367366400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1404777600000",
    "number": "1780029074",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25932 DEQUINDRE RD STE C",
            "city": "WARREN",
            "state": "MI",
            "postal_code": "480911071",
            "telephone_number": "248-275-5221",
            "fax_number": "586-486-5552"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25932 DEQUINDRE RD STE C",
            "city": "WARREN",
            "state": "MI",
            "postal_code": "480911071",
            "telephone_number": "248-275-5221",
            "fax_number": "586-486-5552"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EZ REST RE-HAB CENTER INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-05-01",
        "last_updated": "2014-07-08",
        "status": "A",
        "authorized_official_last_name": "WOLODKOWICZ",
        "authorized_official_first_name": "MARK",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "248-275-5221",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "MI",
            "license": null,
            "primary": false
        },
        {
            "code": "208VP0014X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pain Medicine, Interventional Pain Medicine",
            "state": "MI",
            "license": "4301039079",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": "MI",
            "license": "5501005051",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2014; 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.