Provider Demographics
NPI:1871709691
Name:REHABILITATION SPECIALISTS TOP OF TROY PC
Entity type:Organization
Organization Name:REHABILITATION SPECIALISTS TOP OF TROY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PT
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:BRICKEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-989-9422
Mailing Address - Street 1:1037 WATER ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:PORT HURON
Mailing Address - State:MI
Mailing Address - Zip Code:48060-4408
Mailing Address - Country:US
Mailing Address - Phone:810-982-9541
Mailing Address - Fax:810-982-5349
Practice Address - Street 1:5600 CROOKS RD
Practice Address - Street 2:SUITE 104
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48098-2811
Practice Address - Country:US
Practice Address - Phone:248-989-9422
Practice Address - Fax:248-989-9424
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-16
Last Update Date:2011-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501001690225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI650F357670OtherBCBSM
MI650F328150OtherBCBSM
MI5501001690OtherLICENSE
MI0G41257OtherBCBSM