Provider Demographics
NPI:1861004921
Name:WAHID, ABDUL (RPT)
Entity Type:Individual
Prefix:
First Name:ABDUL
Middle Name:
Last Name:WAHID
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46547 INVERNESS RD
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48188-3051
Mailing Address - Country:US
Mailing Address - Phone:313-610-4448
Mailing Address - Fax:
Practice Address - Street 1:46547 INVERNESS RD
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48188-3051
Practice Address - Country:US
Practice Address - Phone:313-610-4448
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-20
Last Update Date:2020-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501006223225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist