Provider Demographics
NPI:1104830066
Name:BASHAN, IRIS (PT)
Entity Type:Individual
Prefix:MRS
First Name:IRIS
Middle Name:
Last Name:BASHAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:IRIS
Other - Middle Name:
Other - Last Name:LADEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:42615 GARFIELD ROAD
Mailing Address - Street 2:
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48038
Mailing Address - Country:US
Mailing Address - Phone:586-412-2646
Mailing Address - Fax:586-412-7087
Practice Address - Street 1:7057 DEXTER ANN ARBOR RD
Practice Address - Street 2:T HERRLINGER & ASSOC
Practice Address - City:DEXTER
Practice Address - State:MI
Practice Address - Zip Code:48130
Practice Address - Country:US
Practice Address - Phone:734-426-3768
Practice Address - Fax:734-426-1406
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501012361225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist