Provider Demographics
NPI:1043998198
Name:JAMALALDIN, AHMED I (PTA)
Entity Type:Individual
Prefix:MR
First Name:AHMED
Middle Name:I
Last Name:JAMALALDIN
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24100 DRAKE RD STE C
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48335-3155
Mailing Address - Country:US
Mailing Address - Phone:248-516-3960
Mailing Address - Fax:248-426-8646
Practice Address - Street 1:24100 DRAKE RD STE C
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48335-3155
Practice Address - Country:US
Practice Address - Phone:248-516-3960
Practice Address - Fax:248-426-8646
Is Sole Proprietor?:No
Enumeration Date:2023-07-10
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5502006398225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant