Provider Demographics
NPI:1083349138
Name:SOURI, GHASSAN (REHABILITATION ENG)
Entity Type:Individual
Prefix:
First Name:GHASSAN
Middle Name:
Last Name:SOURI
Suffix:
Gender:M
Credentials:REHABILITATION ENG
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43000 W 9 MILE RD STE 113
Mailing Address - Street 2:
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48375-4180
Mailing Address - Country:US
Mailing Address - Phone:248-974-6118
Mailing Address - Fax:
Practice Address - Street 1:43000 W 9 MILE RD STE 113
Practice Address - Street 2:
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48375-4180
Practice Address - Country:US
Practice Address - Phone:248-974-6118
Practice Address - Fax:248-348-7131
Is Sole Proprietor?:No
Enumeration Date:2022-07-22
Last Update Date:2022-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner