Basic Information
| Provider Information | |||||||||
| NPI: | 1780816033 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | PARAMOUNT REHABILITATION SERVICES, PC | ||||||||
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| OtherOrganizationName: | PARAMOUNT REHABILITATION SERVICES, PC | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6161 STATE ST | ||||||||
| Address2: | |||||||||
| City: | SAGINAW | ||||||||
| State: | MI | ||||||||
| PostalCode: | 486033426 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9897903781 | ||||||||
| FaxNumber: | 9897903782 | ||||||||
| Practice Location | |||||||||
| Address1: | 6161 STATE ST | ||||||||
| Address2: | |||||||||
| City: | SAGINAW | ||||||||
| State: | MI | ||||||||
| PostalCode: | 486033426 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9897903781 | ||||||||
| FaxNumber: | 9897903782 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/20/2009 | ||||||||
| LastUpdateDate: | 06/13/2022 | ||||||||
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| AuthorizedOfficialLastName: | MALEWAR | ||||||||
| AuthorizedOfficialFirstName: | MANJUSHA | ||||||||
| AuthorizedOfficialMiddleName: | SUNIL | ||||||||
| AuthorizedOfficialTitleorPosition: | REHAB DIRECTOR / PHYSICAL THERAPIST | ||||||||
| AuthorizedOfficialTelephone: | 9897903781 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | PARAMOUNT REHABILITATION SERVICES | ||||||||
| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | RPT | ||||||||
| NPICertificationDate: | 05/24/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 5501006073 | MI | N | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225100000X | 5501013753 | MI | N | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225XH1200X | 1051100450 | MI | N | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Hand | 225XP0019X | 1022345 | MI | N | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Physical Rehabilitation | 225XP0200X | 5201000937 | MI | N | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Pediatrics | 235Z00000X | 01092746 | MI | N | 193200000X MULTI-SPECIALTY GROUP | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | 235Z00000X | 00999953 | MI | N | 193200000X MULTI-SPECIALTY GROUP | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | 235Z00000X | 01131136 | MI | N | 193200000X MULTI-SPECIALTY GROUP | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | 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 | 404679870 | 05 | MI | MEDICAID | 0987906 | 01 | MI | HEALTH PLUS | OTHER | 30738 | 01 | MI | BLUE CROSS AND BLUE SHIELD OF MICHIGAN | OTHER |