Provider Demographics
NPI:1518940055
Name:MASIH, ANUJ (MPT)
Entity Type:Individual
Prefix:
First Name:ANUJ
Middle Name:
Last Name:MASIH
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4646 GARDEN CITY DR
Mailing Address - Street 2:
Mailing Address - City:LITHONIA
Mailing Address - State:GA
Mailing Address - Zip Code:30038-6240
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1506 KLONDIKE RD SW
Practice Address - Street 2:SUITE 202
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30094-5173
Practice Address - Country:US
Practice Address - Phone:404-510-5007
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-29
Last Update Date:2012-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT008482225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist