Provider Demographics
NPI:1821465295
Name:AKHTAR, MAHMOOD (PT)
Entity Type:Individual
Prefix:
First Name:MAHMOOD
Middle Name:
Last Name:AKHTAR
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 1:21413 BROOKLYN BRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:MACOMB
Mailing Address - State:MI
Mailing Address - Zip Code:48044-6402
Mailing Address - Country:US
Mailing Address - Phone:248-778-8986
Mailing Address - Fax:
Practice Address - Street 1:21413 BROOKLYN BRIDGE DR
Practice Address - Street 2:
Practice Address - City:MACOMB
Practice Address - State:MI
Practice Address - Zip Code:48044-6402
Practice Address - Country:US
Practice Address - Phone:248-778-8986
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-01
Last Update Date:2015-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501007340225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist