Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 5501015323 | MI |
NPI | 1003110958 |
---|---|
Provider Name | Eliza Abbasi |
First Address | Bolingbrook, IL 60440-4909 |
Second Address | Waterford, MI 48327-1970 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/01/2011 |
Last Update Date | 26/01/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
5501015323 | PHYSICAL THERAPY LICENSE NUMBER (01) | MI |