Provider Demographics
NPI:1700387677
Name:ANWAR, KHURSHEED (PT)
Entity Type:Individual
Prefix:
First Name:KHURSHEED
Middle Name:
Last Name:ANWAR
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22811 W 7 MILE RD
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48219-1739
Mailing Address - Country:US
Mailing Address - Phone:313-534-1440
Mailing Address - Fax:313-534-0643
Practice Address - Street 1:22811 W 7 MILE RD
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48219-1739
Practice Address - Country:US
Practice Address - Phone:313-534-1440
Practice Address - Fax:313-534-0643
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-26
Last Update Date:2018-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501004931225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist