Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 5501013717 | MI |
N | 2251G0304X | Physical Therapist - Geriatrics | 5501013717 | MI |
N | 2251H1200X | Hand | 5501013717 | MI |
N | 2251N0400X | Physical Therapist - Neurology | 5501013717 | MI |
N | 2251S0007X | Physical Therapist - Sports | 5501013717 | MI |
N | 2251X0800X | Physical Therapist - Orthopedic | 5501013717 | MI |
NPI | 1245730076 |
---|---|
Provider Name | Dr. Hisham Fittahy |
First Address | Taylor, MI 48180-3334 |
Second Address | Taylor, MI 48180-3334 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/02/2018 |
Last Update Date | 04/09/2019 |