Provider Demographics
NPI:1043873201
Name:NAHABETIAN, DAVID (LMT)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:
Last Name:NAHABETIAN
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42124 PELLSTON DR
Mailing Address - Street 2:
Mailing Address - City:NORTHVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48167-2414
Mailing Address - Country:US
Mailing Address - Phone:248-797-9971
Mailing Address - Fax:
Practice Address - Street 1:42124 PELLSTON DR
Practice Address - Street 2:
Practice Address - City:NORTHVILLE
Practice Address - State:MI
Practice Address - Zip Code:48167-2414
Practice Address - Country:US
Practice Address - Phone:248-797-9971
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-15
Last Update Date:2019-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7501001727225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist