Provider Demographics
NPI:1114128097
Name:AWAN, RUMANA (PT)
Entity Type:Individual
Prefix:MS
First Name:RUMANA
Middle Name:
Last Name:AWAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:0-535 LEONARD N.W.
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49544
Mailing Address - Country:US
Mailing Address - Phone:616-791-2945
Mailing Address - Fax:616-785-1201
Practice Address - Street 1:1505 3 MILE RD. N.W.
Practice Address - Street 2:STE. B
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49544
Practice Address - Country:US
Practice Address - Phone:616-785-8535
Practice Address - Fax:616-785-1201
Is Sole Proprietor?:No
Enumeration Date:2007-05-30
Last Update Date:2015-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501002980174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist