Provider Demographics
NPI:1467004531
Name:CHOWDHURY, NAZMUL HAQUE (PTA)
Entity Type:Individual
Prefix:
First Name:NAZMUL
Middle Name:HAQUE
Last Name:CHOWDHURY
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3238 ESCH DR
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48091-3338
Mailing Address - Country:US
Mailing Address - Phone:313-721-0412
Mailing Address - Fax:
Practice Address - Street 1:14151 15 MILE RD
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48312-5507
Practice Address - Country:US
Practice Address - Phone:586-939-0200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-09
Last Update Date:2019-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5502002866225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant