Provider Demographics
NPI:1821654351
Name:FAZAL, MUHAMMAD (PT)
Entity Type:Individual
Prefix:
First Name:MUHAMMAD
Middle Name:
Last Name:FAZAL
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 1:5760 HOUGHTEN DR
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48098-2911
Mailing Address - Country:US
Mailing Address - Phone:313-377-5818
Mailing Address - Fax:
Practice Address - Street 1:5760 HOUGHTEN DR
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48098-2911
Practice Address - Country:US
Practice Address - Phone:313-377-5818
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-09
Last Update Date:2022-09-13
Deactivation Date:2020-08-31
Deactivation Code:
Reactivation Date:2022-07-11
Provider Licenses
StateLicense IDTaxonomies
MI5501007113225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist