Provider Demographics
NPI:1518277854
Name:BASRAI, ALIFIYA TAHER (PT)
Entity Type:Individual
Prefix:
First Name:ALIFIYA
Middle Name:TAHER
Last Name:BASRAI
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:ALIFIYA
Other - Middle Name:
Other - Last Name:BHARMAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 306393
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37230-6393
Mailing Address - Country:US
Mailing Address - Phone:615-373-1350
Mailing Address - Fax:615-373-7116
Practice Address - Street 1:1525 GUNBARREL RD STE 105
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-4832
Practice Address - Country:US
Practice Address - Phone:423-894-4188
Practice Address - Fax:423-894-4185
Is Sole Proprietor?:No
Enumeration Date:2010-10-20
Last Update Date:2020-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN12725225100000X
IL070-019038225100000X
NY032650225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACB241886Medicare UPIN