Basic Information
Provider Information | |||||||||
NPI: | 1699820258 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | PARAMOUNT REHABILITATION SERVICES, PC | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: | PARAMOUNT REHABILITATION SERVICES, PC | ||||||||
OtherOrganizationType: | 3 | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 2535 22ND ST | ||||||||
Address2: |   | ||||||||
City: | BAY CITY | ||||||||
State: | MI | ||||||||
PostalCode: | 48708 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9898919800 | ||||||||
FaxNumber: | 9898910800 | ||||||||
Practice Location | |||||||||
Address1: | 2535 22ND ST | ||||||||
Address2: |   | ||||||||
City: | BAY CITY | ||||||||
State: | MI | ||||||||
PostalCode: | 48708 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9898919800 | ||||||||
FaxNumber: | 9898910800 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 01/24/2007 | ||||||||
LastUpdateDate: | 06/13/2022 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | MALEWAR | ||||||||
AuthorizedOfficialFirstName: | MANJUSHA | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: | ADMINSTRATOR | ||||||||
AuthorizedOfficialTelephone: | 9898919800 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: | MR. | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: | R.P.T. | ||||||||
NPICertificationDate: | 06/13/2022 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X |   |   | N | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |   | 225X00000X | 5201004313 | MI | N | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |   | 225XH1200X | 1051100450 | MI | N | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Hand | 235Z00000X | 01092746 | MI | N | 193200000X MULTI-SPECIALTY GROUP | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |   | 332B00000X |   |   | N |   | Suppliers | Durable Medical Equipment & Medical Supplies |   | 225100000X | 5501006073 | MI | N | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |   | 225100000X | 5501003922 | MI | N | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |   | 225100000X | 5501005570 | MI | Y | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |   |
ID Information
ID | Type | State | Issuer | Description | 30738 | 01 | MI | BLUE CARE NETWORK | OTHER | 1017353 | 01 | MI | MCLAREN HEALTH PLAN | OTHER | 30738 | 01 | MI | BLUE CROSS BLUE SHIELD | OTHER | 404679870 | 05 | MI |   | MEDICAID | 0987906 | 01 | MI | HEALTH PLUS | OTHER |