Provider Demographics
NPI:1912212697
Name:AZAD, SHAHZAD MOHAMMED (PT)
Entity Type:Individual
Prefix:
First Name:SHAHZAD
Middle Name:MOHAMMED
Last Name:AZAD
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 1:17061 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HESPERIA
Mailing Address - State:CA
Mailing Address - Zip Code:92345-6067
Mailing Address - Country:US
Mailing Address - Phone:760-956-4126
Mailing Address - Fax:
Practice Address - Street 1:17061 MAIN ST
Practice Address - Street 2:
Practice Address - City:HESPERIA
Practice Address - State:CA
Practice Address - Zip Code:92345-6067
Practice Address - Country:US
Practice Address - Phone:760-956-4126
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-18
Last Update Date:2013-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA36727225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAEP927ZOtherTPAN