Provider Demographics
NPI:1679529218
Name:TAL-HENIG, AMIRA (PT)
Entity Type:Individual
Prefix:
First Name:AMIRA
Middle Name:
Last Name:TAL-HENIG
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 1:2725 PACKARD STREET, SUITE 102
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48108
Mailing Address - Country:US
Mailing Address - Phone:734-222-8515
Mailing Address - Fax:734-222-8520
Practice Address - Street 1:2725 PACKARD STREET, SUITE 102
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48108
Practice Address - Country:US
Practice Address - Phone:734-222-8515
Practice Address - Fax:734-222-8520
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2016-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501004165225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0N92250Medicare ID - Type Unspecified