Provider Demographics
NPI:1609303957
Name:ADVANCE THERAPY & REHAB INC
Entity type:Organization
Organization Name:ADVANCE THERAPY & REHAB INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ATEF
Authorized Official - Middle Name:
Authorized Official - Last Name:HAMAD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-525-1113
Mailing Address - Street 1:PO BOX 510655
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48151-6655
Mailing Address - Country:US
Mailing Address - Phone:313-948-3050
Mailing Address - Fax:313-948-3080
Practice Address - Street 1:24350 JOY RD STE 2
Practice Address - Street 2:
Practice Address - City:REDFORD
Practice Address - State:MI
Practice Address - Zip Code:48239-1265
Practice Address - Country:US
Practice Address - Phone:313-948-3050
Practice Address - Fax:313-948-3080
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-17
Last Update Date:2018-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501006662225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty