Provider Demographics
NPI:1184039786
Name:AFROZ, JAMAL
Entity Type:Individual
Prefix:MS
First Name:JAMAL
Middle Name:
Last Name:AFROZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18591 CLAIRMONT CIR E
Mailing Address - Street 2:
Mailing Address - City:NORTHVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48168-8539
Mailing Address - Country:US
Mailing Address - Phone:734-925-3815
Mailing Address - Fax:
Practice Address - Street 1:18591 CLAIRMONT CIR E
Practice Address - Street 2:
Practice Address - City:NORTHVILLE
Practice Address - State:MI
Practice Address - Zip Code:48168-8539
Practice Address - Country:US
Practice Address - Phone:734-925-3815
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-23
Last Update Date:2014-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501006578225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist