Provider Demographics
NPI:1679049563
Name:ZWEN, SAFA
Entity Type:Individual
Prefix:
First Name:SAFA
Middle Name:
Last Name:ZWEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:NONE
Other - Middle Name:NONE
Other - Last Name:ZOWAINI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:24354 FORDSON HWY
Mailing Address - Street 2:
Mailing Address - City:DEARBORN HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48127-1332
Mailing Address - Country:US
Mailing Address - Phone:313-467-4642
Mailing Address - Fax:
Practice Address - Street 1:24354 FORDSON HWY
Practice Address - Street 2:
Practice Address - City:DEARBORN HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48127-1332
Practice Address - Country:US
Practice Address - Phone:313-467-4642
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-17
Last Update Date:2018-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPTA49399225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant