Provider Demographics
NPI:1992852255
Name:NDAW, ABDOULAYE (PT)
Entity Type:Individual
Prefix:MR
First Name:ABDOULAYE
Middle Name:
Last Name:NDAW
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 1:2063 RAWSONVILLE RD
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48111-2219
Mailing Address - Country:US
Mailing Address - Phone:734-485-4544
Mailing Address - Fax:734-485-8125
Practice Address - Street 1:2063 RAWSONVILLE RD
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:MI
Practice Address - Zip Code:48111-2219
Practice Address - Country:US
Practice Address - Phone:734-485-4544
Practice Address - Fax:734-485-8125
Is Sole Proprietor?:No
Enumeration Date:2007-01-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501004671225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI23-6559Medicare ID - Type Unspecified