Provider Demographics
NPI:1295034098
Name:BASHIR, HUMERA (PT)
Entity Type:Individual
Prefix:MRS
First Name:HUMERA
Middle Name:
Last Name:BASHIR
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 1:704 ZORN AVE
Mailing Address - Street 2:GREENLEAVES APPT #10
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40206-1492
Mailing Address - Country:US
Mailing Address - Phone:502-296-7692
Mailing Address - Fax:
Practice Address - Street 1:704 ZORN AVE
Practice Address - Street 2:GREENLEAVES APPT #10
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40206-1492
Practice Address - Country:US
Practice Address - Phone:502-296-7692
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-18
Last Update Date:2011-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY005637225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist