Provider Demographics
NPI:1275730608
Name:ALKHALIL, NASSER KASSEM (RPT)
Entity Type:Individual
Prefix:
First Name:NASSER
Middle Name:KASSEM
Last Name:ALKHALIL
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22725 SHERIDAN ST
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48128-1832
Mailing Address - Country:US
Mailing Address - Phone:313-406-5678
Mailing Address - Fax:
Practice Address - Street 1:22725 SHERIDAN ST
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48128-1832
Practice Address - Country:US
Practice Address - Phone:313-406-5678
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501006695225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist