Provider Demographics
NPI:1447982699
Name:METRO-STRENGTH PERFORMANCE REHAB
Entity type:Organization
Organization Name:METRO-STRENGTH PERFORMANCE REHAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DERRIK
Authorized Official - Middle Name:
Authorized Official - Last Name:FAUNT
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:313-240-9700
Mailing Address - Street 1:1325 E 11 MILE RD
Mailing Address - Street 2:
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48067-2051
Mailing Address - Country:US
Mailing Address - Phone:313-240-9700
Mailing Address - Fax:
Practice Address - Street 1:1325 E 11 MILE RD
Practice Address - Street 2:
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48067-2051
Practice Address - Country:US
Practice Address - Phone:313-240-9700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-27
Last Update Date:2022-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical TherapyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1922664341OtherBLUECROSS