Provider Demographics
NPI:1063658458
Name:ABEDIN, SHAWKAT MOHAMMAD (PT)
Entity Type:Individual
Prefix:
First Name:SHAWKAT
Middle Name:MOHAMMAD
Last Name:ABEDIN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:MOHAMMAD
Other - Middle Name:SHAWKAT
Other - Last Name:ABEDIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:21700 NORTHWESTERN HWY
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-4906
Mailing Address - Country:US
Mailing Address - Phone:248-798-3293
Mailing Address - Fax:
Practice Address - Street 1:35501 MOUND RD
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48310-4724
Practice Address - Country:US
Practice Address - Phone:248-798-3293
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-06
Last Update Date:2021-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT006853225100000X
MI5501016463225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist